Comparison of fracture risk prediction by the US preventive services task force strategy and two alternative strategies in women 50-64 years old in the women's health initiative

Carolyn J. Crandall, Joseph C. Larson, Nelson B. Watts, Margaret L. Gourlay, Meghan G. Donaldson, Andrea LaCroix, Jane A. Cauley, Jean Wactawski-Wende, Margery L. Gass, John A Robbins, Kristine E. Ensrud

Research output: Contribution to journalArticle

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Abstract

Context: The United States Preventive Services Task Force (USPSTF) recommends osteoporosis screening for women younger than 65 years whose 10-year predicted risk of major osteoporotic fracture (MOF) is at least 9.3% using the Fracture Risk Assessment Tool. In postmenopausal women age 50-64 years old, it is uncertain how the USPSTF screening strategy compares with the Osteoporosis Self-Assessment Tool and the Simple Calculated Osteoporosis Risk Estimate (SCORE) in discriminating women who will and will not experience MOF. Objective: This study aimed to assess the sensitivity, specificity, and area under the receiver operating characteristic curve of the three strategies for discrimination of incident MOF over 10 years of follow-up among postmenopausal women age 50-64 years. Setting and Design: This was a prospective study conducted between 1993-2008 at 40 US Centers. Participants: We analyzed data from participants of the Women's Health Initiative Observational Study and Clinical Trials, age 50-64 years, not taking osteoporosis medication (n = 62 492). Main Outcome Measures: The main outcome was 10-year (observed) incidence of MOF. Results: For identifying women with incident MOF, sensitivity of the strategies ranged from 25.8-39.8%, specificity ranged from 60.7-65.8%, and AUC values ranged from 0.52-0.56. The sensitivity of the USPSTF strategy for identifying incident MOF ranged from 4.7% (3.3-6.0) among women age 50-54 years to 37.3% (35.4-39.1) for women age 60-64 years. Adjusting the thresholds to improve sensitivity resulted in decreased specificity. Conclusions: Our findings do not support use of the USPSTF strategy, Osteoporosis Self-Assessment Tool, or SCORE to identify younger postmenopausal women who are at higher risk of fracture. Our findings suggest that fracture prediction in younger postmenopausal women requires assessment of risk factors not included in currently available strategies.

Original languageEnglish (US)
Pages (from-to)4514-4522
Number of pages9
JournalJournal of Clinical Endocrinology and Metabolism
Volume99
Issue number12
DOIs
StatePublished - Dec 1 2014

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Women's Health
Advisory Committees
Osteoporotic Fractures
Osteoporosis
Screening
ROC Curve
Risk assessment
Area Under Curve
Observational Studies
Outcome Assessment (Health Care)
Clinical Trials
Prospective Studies
Sensitivity and Specificity
Incidence

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism
  • Medicine(all)

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Comparison of fracture risk prediction by the US preventive services task force strategy and two alternative strategies in women 50-64 years old in the women's health initiative. / Crandall, Carolyn J.; Larson, Joseph C.; Watts, Nelson B.; Gourlay, Margaret L.; Donaldson, Meghan G.; LaCroix, Andrea; Cauley, Jane A.; Wactawski-Wende, Jean; Gass, Margery L.; Robbins, John A; Ensrud, Kristine E.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 99, No. 12, 01.12.2014, p. 4514-4522.

Research output: Contribution to journalArticle

Crandall, Carolyn J. ; Larson, Joseph C. ; Watts, Nelson B. ; Gourlay, Margaret L. ; Donaldson, Meghan G. ; LaCroix, Andrea ; Cauley, Jane A. ; Wactawski-Wende, Jean ; Gass, Margery L. ; Robbins, John A ; Ensrud, Kristine E. / Comparison of fracture risk prediction by the US preventive services task force strategy and two alternative strategies in women 50-64 years old in the women's health initiative. In: Journal of Clinical Endocrinology and Metabolism. 2014 ; Vol. 99, No. 12. pp. 4514-4522.
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title = "Comparison of fracture risk prediction by the US preventive services task force strategy and two alternative strategies in women 50-64 years old in the women's health initiative",
abstract = "Context: The United States Preventive Services Task Force (USPSTF) recommends osteoporosis screening for women younger than 65 years whose 10-year predicted risk of major osteoporotic fracture (MOF) is at least 9.3{\%} using the Fracture Risk Assessment Tool. In postmenopausal women age 50-64 years old, it is uncertain how the USPSTF screening strategy compares with the Osteoporosis Self-Assessment Tool and the Simple Calculated Osteoporosis Risk Estimate (SCORE) in discriminating women who will and will not experience MOF. Objective: This study aimed to assess the sensitivity, specificity, and area under the receiver operating characteristic curve of the three strategies for discrimination of incident MOF over 10 years of follow-up among postmenopausal women age 50-64 years. Setting and Design: This was a prospective study conducted between 1993-2008 at 40 US Centers. Participants: We analyzed data from participants of the Women's Health Initiative Observational Study and Clinical Trials, age 50-64 years, not taking osteoporosis medication (n = 62 492). Main Outcome Measures: The main outcome was 10-year (observed) incidence of MOF. Results: For identifying women with incident MOF, sensitivity of the strategies ranged from 25.8-39.8{\%}, specificity ranged from 60.7-65.8{\%}, and AUC values ranged from 0.52-0.56. The sensitivity of the USPSTF strategy for identifying incident MOF ranged from 4.7{\%} (3.3-6.0) among women age 50-54 years to 37.3{\%} (35.4-39.1) for women age 60-64 years. Adjusting the thresholds to improve sensitivity resulted in decreased specificity. Conclusions: Our findings do not support use of the USPSTF strategy, Osteoporosis Self-Assessment Tool, or SCORE to identify younger postmenopausal women who are at higher risk of fracture. Our findings suggest that fracture prediction in younger postmenopausal women requires assessment of risk factors not included in currently available strategies.",
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AU - Crandall, Carolyn J.

AU - Larson, Joseph C.

AU - Watts, Nelson B.

AU - Gourlay, Margaret L.

AU - Donaldson, Meghan G.

AU - LaCroix, Andrea

AU - Cauley, Jane A.

AU - Wactawski-Wende, Jean

AU - Gass, Margery L.

AU - Robbins, John A

AU - Ensrud, Kristine E.

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N2 - Context: The United States Preventive Services Task Force (USPSTF) recommends osteoporosis screening for women younger than 65 years whose 10-year predicted risk of major osteoporotic fracture (MOF) is at least 9.3% using the Fracture Risk Assessment Tool. In postmenopausal women age 50-64 years old, it is uncertain how the USPSTF screening strategy compares with the Osteoporosis Self-Assessment Tool and the Simple Calculated Osteoporosis Risk Estimate (SCORE) in discriminating women who will and will not experience MOF. Objective: This study aimed to assess the sensitivity, specificity, and area under the receiver operating characteristic curve of the three strategies for discrimination of incident MOF over 10 years of follow-up among postmenopausal women age 50-64 years. Setting and Design: This was a prospective study conducted between 1993-2008 at 40 US Centers. Participants: We analyzed data from participants of the Women's Health Initiative Observational Study and Clinical Trials, age 50-64 years, not taking osteoporosis medication (n = 62 492). Main Outcome Measures: The main outcome was 10-year (observed) incidence of MOF. Results: For identifying women with incident MOF, sensitivity of the strategies ranged from 25.8-39.8%, specificity ranged from 60.7-65.8%, and AUC values ranged from 0.52-0.56. The sensitivity of the USPSTF strategy for identifying incident MOF ranged from 4.7% (3.3-6.0) among women age 50-54 years to 37.3% (35.4-39.1) for women age 60-64 years. Adjusting the thresholds to improve sensitivity resulted in decreased specificity. Conclusions: Our findings do not support use of the USPSTF strategy, Osteoporosis Self-Assessment Tool, or SCORE to identify younger postmenopausal women who are at higher risk of fracture. Our findings suggest that fracture prediction in younger postmenopausal women requires assessment of risk factors not included in currently available strategies.

AB - Context: The United States Preventive Services Task Force (USPSTF) recommends osteoporosis screening for women younger than 65 years whose 10-year predicted risk of major osteoporotic fracture (MOF) is at least 9.3% using the Fracture Risk Assessment Tool. In postmenopausal women age 50-64 years old, it is uncertain how the USPSTF screening strategy compares with the Osteoporosis Self-Assessment Tool and the Simple Calculated Osteoporosis Risk Estimate (SCORE) in discriminating women who will and will not experience MOF. Objective: This study aimed to assess the sensitivity, specificity, and area under the receiver operating characteristic curve of the three strategies for discrimination of incident MOF over 10 years of follow-up among postmenopausal women age 50-64 years. Setting and Design: This was a prospective study conducted between 1993-2008 at 40 US Centers. Participants: We analyzed data from participants of the Women's Health Initiative Observational Study and Clinical Trials, age 50-64 years, not taking osteoporosis medication (n = 62 492). Main Outcome Measures: The main outcome was 10-year (observed) incidence of MOF. Results: For identifying women with incident MOF, sensitivity of the strategies ranged from 25.8-39.8%, specificity ranged from 60.7-65.8%, and AUC values ranged from 0.52-0.56. The sensitivity of the USPSTF strategy for identifying incident MOF ranged from 4.7% (3.3-6.0) among women age 50-54 years to 37.3% (35.4-39.1) for women age 60-64 years. Adjusting the thresholds to improve sensitivity resulted in decreased specificity. Conclusions: Our findings do not support use of the USPSTF strategy, Osteoporosis Self-Assessment Tool, or SCORE to identify younger postmenopausal women who are at higher risk of fracture. Our findings suggest that fracture prediction in younger postmenopausal women requires assessment of risk factors not included in currently available strategies.

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