Estimating regional bone mineral density-based T-scores using clinical information; tools validated for postmenopausal women in Sri Lanka

Hewa Walpola Amila Sewwandi Subasinghe; Sarath Lekamwasam; Patrick Ball; Hana Morrissey; Eisha Waidyaratne

doi:10.1016/j.afos.2020.08.004

Estimating regional bone mineral density-based T-scores using clinical information; tools validated for postmenopausal women in Sri Lanka

Osteoporos Sarcopenia. 2020 Sep;6(3):122-128. doi: 10.1016/j.afos.2020.08.004. Epub 2020 Sep 16.

Authors

Hewa Walpola Amila Sewwandi Subasinghe¹, Sarath Lekamwasam², Patrick Ball³, Hana Morrissey³, Eisha Waidyaratne²

Affiliations

¹ Department of Pharmacy, Faculty of Allied Health Sciences, University of Ruhuna, Sri Lanka.
² Faculty of Medicine, University of Ruhuna, Sri Lanka.
³ School of Pharmacy, University of Wolverhampton, United Kingdom.

Abstract

Objectives: This study aims to develop and validate a country specific osteoporosis risk assessing tool for Sri Lankan postmenopausal women.

Methods: Community-dwelling postmenopausal women were enrolled to development (n = 602) and validation (n = 339) samples. Clinical risk factors (CRFs) of osteoporosis were assessed. Bone mineral densities (BMD) of femoral neck, total hip and lumbar spine were assessed by dual energy X-ray absorptiometry (DXA) scan. Radial ultrasound (US) bone scan was done. Linear regression analysis was performed in development sample considering regional BMDs as dependent and CRFs as independent variables. Regression equations were developed to estimate regional BMDs using best predictive CRFs. Sensitivity, specificity, positive and negative predictive values (PPV and NPV) were assessed to validate the new tools.

Results: Age, body weight and US T-scores showed positive correlations with BMDs of all 3 sites. Two osteoporosis risk assessing tools (OPRATs) were developed as OPRAT-1 and OPRAT-2. Prevalence of osteoporosis, in the validation sample was 74.3%. Sensitivity were high in both tools (OPRAT-1 and OPRAT-2; 83.2% and 82.5%) while specificity were moderate (44.8% for both). PPV of OPRAT-1 and OPRAT-2 were 79.5% and 81.2%. Both tools showed moderate NPV (OPRAT-1 and OPRAT-2; 51% and 47%).

Conclusions: Both OPRAT-1 and OPRAT-2 have high performance in screening postmenopausal women in Sri Lanka for risk of osteoporosis. OPRAT-2 is more convenient and can be used in any healthcare setting with limited resources to identify women who will be benefitted by DXA. OPRAT-1 can be used if the radial US facility is available.

Keywords: Bone mineral density; Osteoporosis; Postmenopausal women; Screening; Sri Lanka.