Sensitivity, specificity, positive and negative predictive values of the criteria for indicating a bone densitometry in the Evaluation of Medical Techniques and Research in Cataluña

Roig Vilaseca, Daniel; Valero García, Carles; Pilar Boncompte Vilanova, M.; Muñoz López, Juli; Contreras García, Carme; Romera Baurés, Montserrat

doi:10.1016/S2173-5743(11)70035-1

Article information

Abstract

The Catalan Agency for Health Technology Assessment and Research (AETIM) proposed, in 2001, criteria for performing a bone densitometry (BD) for use in the consultations of the public health system.

Objective

To determine the sensitivity, specificity, positive predictive value and negative predictive value of the criteria to indicate BD.

Material and methods

Five groups of volunteers (premenopausal women aged 46 to 65 years, postmenopausal women aged 46 to 65 years, postmenopausal women aged >65 years and men 46 to 65 years and >65 years) underwent BD and a questionnaire on risk factors. The results obtained with the AETIM criteria are related to criteria for indication of BD proposed by the World Health Organization (1999 and 2003 criteria), the National Osteoporosis Foundation (1998 and 2010 criteria) and the International Committee of Clinical Guidelines on Osteoporosis.

Results

Criteria from the Catalan Agency have low sensitivity to detect both low bone mass (T index <−1) and osteoporosis (T index <−2.5), specificity varied according to the group. The positive predictive value is low, but the negative predictive value for osteoporosis is high in all groups (except for postmenopausal women aged >65 years). The remaining criteria have a high negative predictive value and, in women, good sensitivity and low specificity, especially for identifying patients with osteoporosis.

Conclusion

Catalan Agency criteria are useful for selecting patients who would not need BD, but lack sufficient sensitivity to identify individuals with low bone mass. The other criteria also have a high negative predictive value for osteoporosis, and a better sensitivity.

Keywords:

Bone densitometry

Sensibility

Specificity

Positive predictive value

Negative predictive value

Indication

Criteria

Resumen

Objetivo

La Agencia de Evaluación de Tecnologías e Investigación Médicas (AETIM) de Cataluña propuso en 2001 unos criterios de indicación de densitometría ósea (DO) para su uso en las consultas del sistema sanitario público. El objetivo fue conocer la sensibilidad, la especificidad, el valor predictivo positivo (VPP) y valor predictivo negativo (VPN) de los criterios de indicación de DO de la AETIM.

Material y método

Cinco grupos de voluntarios (mujeres premenopáusicas de 46 a 65 años, posmenopáusicas de 46 a 65 años y posmenopáusicas de > 65 años, y varones de 46 a 65 años y de > 65 años) a los que se realizó DO y una encuesta sobre factores de riesgo. Se calcularon la sensibilidad, la especificidad, el VPP y el VPN de los criterios de la AETIM, y los resultados se compararon con los criterios de indicación de DO propuestos por la Organización Mundial de la Salud (en 1999 y 2003), la National Osteoporosis Foundation (en 1998 y 2010) y el Comité Internacional de Guías Clínicas en Osteoporosis.

Resultados

Los criterios de la AETIM tienen una baja sensibilidad tanto para detectar baja masa ósea (índice T < −1) como osteoporosis (índice T < −2,5); la especificidad varía según el grupo. El VPP es bajo, pero el VPN para osteoporosis es alto en todos los grupos (excepto el de mujeres posmenopáusicas > 65 años). El resto de los criterios tienen un VPN alto y, en mujeres, buena sensibilidad y muy baja especificidad, especialmente para identificar pacientes con osteoporosis.

Conclusiones

Los criterios de la AETIM son útiles para seleccionar pacientes a los que no sería necesario realizar una DO, pero carecen de sensibilidad suficiente para identificar individuos con baja masa ósea. El resto de criterios tienen también un VPN alto para osteoporosis y una sensibilidad algo mejor.

Palabras clave:

Densitometría ósea

Sensibilidad

Especificidad

Valor predictivo positivo

Valor predictivo negativo

Indicación

Criterios

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References

[1.]

P. Garsell, O. Johnell, B.E. Nilsson.

Predicting fractures in women by using forearm bone densitometry.

Calcif Tissue Int, 44 (1989), pp. 235-242

Medline

[2.]

S.L. Hui, C.W. Slemenda, P.H. Johnston, C.C. Johnston.

Baseline measurement of bone mass predicts fracture in white women.

Ann Intern Med, 111 (1989), pp. 355-361

Medline

[3.]

S.R. Cummings, D.M. Black, M.C. Nevitt, W.S. Browner, J.A. Cauley, HK Genant, The study of Osteoporotic Fractures Research Group, et al.

Appendicular bone density and age predict hip fracture in women.

JAMA, 263 (1990), pp. 665-668

Medline

[4.]

P.A. Ballard, D.W. Purdie, C.M. Langton, S.A. Steel, S. Mussurakis.

Prevalence of osteoporosis and related risk factors in UK women in the seventh decade: Osteoporosis case finding by clinical referral criteria or predictive model?.

Osteoporosis Int, 8 (1998), pp. 535-539

[5.]

U.S. Preventive Services Task Force.

Screening for osteoporosis in postmenopausal women: Recommendations and rationale.

Ann Int Med, 137 (2002), pp. 526-528

Medline

[6.]

S.M. Cadarette, W.J. McIsaac, G.A. Hawkr, L. Jaakkimainen, A. Culbert, G. Zafira, et al.

The validity of decision rules for selecting women with primary osteoporosis for bone mineral density testing.

Osteopororis Int, 15 (2004), pp. 361-366

[7.]

S.-P. Chan, C.C. Teo, S.A. Ng, N. Goh, C. Tan, M. Deurenberg-Yap.

Validation of various osteoporosis risk indices in elderly Chinese females in Singapore.

Osteoporosis Int, 17 (2006), pp. 1182-1188

[8.]

S.M. Caderette, S.B. Jaglal, T.M. Murray.

Validation of a simple calculated osteoporosis risk estimation (SCORE) for patient selection for bone densitometry.

Osteoporosis Int, 10 (1999), pp. 85-90

[9.]

S.M. Caderette, S.B. Jaglal, N. Kreiger, W.J. McIsaac, G.A. Darlington, J.V. Tu.

Development and validation of the osteoporosis risk assessment instrument to facilitate selection of women for bone densitometry.

CMAJ, 162 (2000), pp. 1289-1294

Medline

[10.]

W. Ben Sedrine, P. Broers, J.P. Devogelaer, G. Depresseux, J.M. Kauffman, S. Goemaere, et al.

Interest of a prescreening questionnaire to reduce the cost of bone densitometry.

Osteoporosis Int, 13 (2002), pp. 434-442

[11.]

D.J.M. Van der Voort, G.J. Dinant, P.E.L.M. Rinkens, C.J.M. Van der Voort-Duindam, J.W.J. Van Wersch, P.P. Geusens.

Construction of an algorithm for quick detection of patients with low bone mineral density and its appplicability in daily general practice.

J Clin Epidemiol, 53 (2000), pp. 1095-1103

Medline

[12.]

F. Richy, M. Gourlay, P.D. Ross, S.S. Sen, L. Radican, F. De Ceulaer, et al.

Validation and comparative evaluation of the osteoporosis self-assessment tool (OST) in a Caucasian population from Belgium.

Q J Med, 97 (2004), pp. 39-46

[13.]

L. Weinsten, B. Ullery, C. Bourguignon.

A simple system to determine who needs osteoporosis screening.

Obstet Gynecol, 93 (1999), pp. 757-760

Medline

[14.]

M. Espallargues, L. Sampietro-Colom, M.D. Estrada, M. Solà, L. Del Río, J. Setoain, et al.

Identifying bone-mass related risk factors for fracture to guide bone densitometry measurements: A systematic review of the literature.

Osteoporosis Int, 12 (2001), pp. 811-822

[15.]

C.C. Johnston, S.R. Cummings, B. Dawson-Hughes, R. Lindsay, L.J. Melton, C.W. Slemenda.

Physician's guide to prevention and treatment of osteoporosis.

National Osteoporosis Fundation, (1998),

[16.]

P.J. Meunier, P.D. Delmas, R. Eastell, M.R. McClung, S. Papapoulos, R. Rizzoli, The International Committe for Osteoporosis Clinical Guidelines..

Diagnosis and manegement of osteoporosis in postmenopausal women Clinical Guidelines.

Clinical Therapeutics, 21 (1999), pp. 1025-1044

Medline

[17.]

H.K. Genant, C. Cooper, G. Poor, I. Reid, G. Ehrlich, J. Kanis, et al.

Interim report and recommendations of the World Health Organization Task-Force for osteoporosis.

Osteoporosis Int, 10 (1999), pp. 259-264

[18.]

Available from: http://www.nof.org/node/42 (quoted 2011 January 5).

[19.]

World Health Organization.

Prevention and management of osteoporosis.

Technical report series 921, WHO, (2003),

[20.]

D. Roig, C. Valero, M. Romera, A. Rozadilla, L. Mateo, X. Juanola, et al.

Prevalencia de los criterios de indicación de densitometría ósea y de los factores de riesgo de baja masa ósea y fractura en unidades extrahospitalarias de Reumatología.

Reumatol Clín, 1 (2005), pp. 12-19

http://dx.doi.org/10.1016/S1699-258X(05)72707-8 | Medline

[21.]

D. Roig Vilaseca, V. Valero.

En nombre del grupo de estudio de criterios de derivación a densitometría Proporción de individuos con criterios de indicación de densitometría ósea y frecuencia de los factores de riesgo de baja masa ósea en consultas de atención primaria.

Aten Primaria, 38 (2006), pp. 437-444

[22.]

M. Díaz Curiel, J.L. Carrasco de la Peña, J. Honorato Pere, R. Pérez Cano, A. Rapado, I. Ruiz Martínez, On behalf on the multicentre research project on osteoporosis.

Study of bone mineral density in lumbar spine and femoral neck in Spanish population.

Osteoporosis Int, 7 (1997), pp. 59-64

[23.]

World Health Organization.

Assessment of fracture risk and its application to screening for postmenopausal osteoporosis.

Technical report series 843, WHO, (1994),

[24.]

D. Martínez-Aguilà, C. Gómez-Vaquero, A. Rozadilla, M. Romera, J. Narváez, J.M. Nolla.

Decision rules for selecting women for bone mineral density testing: Application in postmenopausal women referred to a bone densitometry Unit.

J Rheumatol, 34 (2007), pp. 1307-1312

Medline

[25.]

B. Rud, J. Hilden, L. Hyldstrup, A. Hróbjartsson.

Performance of the osteoporosis self-assessment tool in rouling out low bone mineral density in postmenopausal women: A systematic review.

Osteoporos Int, 18 (2007), pp. 1177-1188

http://dx.doi.org/10.1007/s00198-006-0319-3 | Medline

[26.]

K.F. Mauck, M.-T. Cuddihy, E.J. Atkinson, L.J. Melton.

Use of clinical preiction rules in detecting osteoporosis in a population-based sample of postmenopausal women.

Arch Intern Med, 165 (2005), pp. 530-536

http://dx.doi.org/10.1001/archinte.165.5.530 | Medline

[27.]

S.M. Cadarette, S.B. Jaglal, T.M. Murria, W.J. McIsaac, L. Joseph, J.P. Brown, For the Canadian Multicentre Osteoporosis Study (CaMos).

Evaluation of decision rules for refering women for bone densitometry by dual-energy X-ray absorptiometry.

JAMA, 286 (2001), pp. 57-63

Medline

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