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Evidence-Based Nursing Online First, published on February 16, 2015 as 10.1136/eb-2014-101953

Adult nursing

Cross-sectional study

An online system shows promise for the early detection of osteoporosis in Asian women 10.1136/eb-2014-101953

Carl M Harper Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA Correspondence to: Dr Carl M Harper, Department of Orthopaedic Surgery, Harvard Medical School, 55 Fruit Street, White Building 535, Boston, MA 02114, USA; [email protected]

validity. The sensitivity, specificity, positive predictive value and negative predictive value were assessed using stepwise regression. Linear regression analysis was used to determine the cut-off point for osteoporosis risk, which was then compared to the International Osteoporosis Foundation’s ‘one minute osteoporosis risk test’ (Ohio Mortuary Operational Response Team (OMORT)).

Findings The accuracy of the OSLDS was 73% (75% sensitivity and 75% specificity). Positive predictive value was 75% and negative predictive value was 75%. When compared to the OMORT, the OSLDS was superior at predicting osteoporosis risk (24% vs 11%). The specific variables which predicted osteoporosis in the OSLDS were: drinking coffee every day, perceived humpback deformity, outdoor activity, wearing high heels and drinking alcohol/smoking regularly. This contrasted to the OMORT where only two questions were effective for predicting osteoporosis.

Commentary

Osteoporosis implications with regard to fragility fracture have been well established, causing a high cost to society and imparting significant morbidity to the patient. This study was conducted in Taiwan where the prevalence of osteoporosis in adults older than 35 years has been estimated at approximately 11%, with the female population having a nearly three times higher prevalence (14.9%) compared to their male counterparts (6%). The study sought to determine if a series of questions directly targeting the female population could predict the prevalence of osteoporosis in this Taiwanese population.

The authors focussed on population-specific variables and then compared these variables to another well-known metric, the OMORT. The methods by which OSLDS was evaluated were rigorous, both evaluating the questionnaire’s applicability with experts in the field, as well as performing stepwise and linear regression analysis to compare it to another known and accepted tool. The external validity of the study is markedly limited as it is unique to the female population of Taiwan. However, this should not be seen as a negative factor as this was the main focus of the study— to determine a population-specific metric to evaluate osteoporosis risk. The application of this tool to populations outside of Taiwan is questionable. However, its utility within this group has been well established and could be employed with confidence. Furthermore, the research focus of the study is commendable and forward thinking. This study has two main deficiencies, which, given the scope of the project, is understandable. The first is that the FRAX algorithm was not compared to the OSLDS. The FRAX algorithm has been validated in numerous populations and serves as a fast and accurate metric by which to assess osteoporosis risk.1 2 The second shortcoming is that the male population was not addressed at all. While it is well established that osteoporosis has a higher prevalence in women than men, osteoporosis risk and fragility fracture prevalence have been shown to be a very real and under recognised phenomenon in the male patient population.3 4 Future work should continue to identify population-specific metrics to estimate the risk of osteoporosis in male and female patients.

Methods

Competing interests None.

Commentary on: Chang SF, Hong CM, Yang RS. The performance of an online osteoporosis detection system a sensitivity and specificity analysis. J Clin Nurs 2014;23:1803–9.

Implications for practice and research ▪ Non-invasive methods are needed to accurately predict osteoporosis risk in the female patient population. ▪ The ability of technology-driven tools to quickly and accurately identify patients at risk for osteoporosis need to be investigated further.

Context

This was a population-based study in which 3770 women over the age of 30 who underwent a Dual-energy X-ray absorptiometry (DXA) scan were identified for potential inclusion. Using a random sampling technique 700 patients were selected for the development of a computer database and a further 167 were selected for software verification ( power analysis indicated that 67 patients were needed for 80% power). A self-report questionnaire was developed based on risk factors cited in international and domestic literature (‘osteoporosis online detection system’ or OSLDS). Experts in the field were employed to determine its applicability and

References 1. Kanis JA, Oden A, Johnell O, et al. The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 2007;18:1033–46. 2. Shuler FD, Conjeski J, Kendall D, et al. Understanding the burden of osteoporosis and use of the World Health Organization FRAX. Orthopedics 2012;35:798–805. 3. Adler RA. Osteoporosis in men: recent progress. Endocrine 2013;44:40–6. 4. Alswat K, Adler SM. Gender differences in osteoporosis screening: retrospective analysis. Arch Osteoporos 2012;7:311–13.

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An online system shows promise for the early detection of osteoporosis in Asian women Carl M Harper Evid Based Nurs published online February 16, 2015

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An online system shows promise for the early detection of osteoporosis in Asian women.

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