Yonsei Med J.  2016 Jan;57(1):187-196. 10.3349/ymj.2016.57.1.187.

Development and Validation of Osteoporosis Risk-Assessment Model for Korean Men

• Oh SM
• Song BM
• Nam BH
• Rhee Y
• Moon SH
• Kim DY
• Kang DR
• Kim HC

• KMID: 2466369
• DOI: http://doi.org/10.3349/ymj.2016.57.1.187

Abstract

PURPOSE
The aim of the present study was to develop an osteoporosis risk-assessment model to identify high-risk individuals among Korean men.
MATERIALS AND METHODS
The study used data from 1340 and 1110 men > or =50 years who participated in the 2009 and 2010 Korean National Health and Nutrition Examination Survey, respectively, for development and validation of an osteoporosis risk-assessment model. Osteoporosis was defined as T score < or =-2.5 at either the femoral neck or lumbar spine. Performance of the candidate models and the Osteoporosis Self-assessment Tool for Asian (OSTA) was compared with sensitivity, specificity, and area under the receiver operating characteristics curve (AUC). A net reclassification improvement was further calculated to compare the developed Korean Osteoporosis Risk-Assessment Model for Men (KORAM-M) with OSTA.
RESULTS
In the development dataset, the prevalence of osteoporosis was 8.1%. KORAM-M, consisting of age and body weight, had a sensitivity of 90.8%, a specificity of 42.4%, and an AUC of 0.666 with a cut-off score of -9. In the validation dataset, similar results were shown: sensitivity 87.9%, specificity 39.7%, and AUC 0.638. Additionally, risk categorization with KORAM-M showed improved reclassification over that of OSTA up to 22.8%.
CONCLUSION
KORAM-M can be simply used as a pre-screening tool to identify candidates for dual energy X-ray absorptiometry tests.

Keyword

Osteoporosis; risk assessment; men; Korea

MeSH Terms

Aged
Asian Continental Ancestry Group/*statistics & numerical data
Bone Density
Female
Humans
Male
Middle Aged
*Models, Biological
Nutrition Surveys
Osteoporosis/*diagnosis/ethnology
Predictive Value of Tests
Prevalence
ROC Curve
Reproducibility of Results
Republic of Korea/epidemiology
Risk Assessment/*methods
Sensitivity and Specificity
Surveys and Questionnaires/*standards

Reference

1. World Health Organization. Prevention and management of osteoporosis Switzerland. Geneva: WHO Press;2003.

2. Ström O, Borgström F, Kanis JA, Compston J, Cooper C, McCloskey EV, et al. Osteoporosis: burden, health care provision and opportunities in the EU: a report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos. 2011; 6:59–155.

3. MOHW and KCDC. Korea Health Statistics 2009: Korean National Health and Nutrition Examination Survey (KNHANES IV-3). Osong: Ministry of Health and Social Welfare and Korea Centers for Disease Control & Prevention;2010.

4. Kiebzak GM, Beinart GA, Perser K, Ambrose CG, Siff SJ, Heggeness MH. Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med. 2002; 162:2217–2222.

5. Haney EM, Bliziotes MM. Male osteoporosis: new insights in an understudied disease. Curr Opin Rheumatol. 2008; 20:423–428.

6. Seeman E. Unresolved issues in osteoporosis in men. Rev Endocr Metab Disord. 2001; 2:45–64.

7. Chang KP, Center JR, Nguyen TV, Eisman JA. Incidence of hip and other osteoporotic fractures in elderly men and women: Dubbo Osteoporosis Epidemiology Study. J Bone Miner Res. 2004; 19:532–536.

8. Krieg MA, Barkmann R, Gonnelli S, Stewart A, Bauer DC, Del Rio Barquero L, et al. Quantitative ultrasound in the management of osteoporosis: the 2007 ISCD Official Positions. J Clin Densitom. 2008; 11:163–187.

9. Nelson HD, Haney EM, Dana T, Bougatsos C, Chou R. Screening for osteoporosis: an update for the U.S. Preventive Services Task Force. Ann Intern Med. 2010; 153:99–111.

10. Lim LS, Hoeksema LJ, Sherin K. Screening for osteoporosis in the adult U.S. population: ACPM position statement on preventive practice. Am J Prev Med. 2009; 36:366–375.

11. Michaëlsson K, Bergström R, Mallmin H, Holmberg L, Wolk A, Ljunghall S. Screening for osteopenia and osteoporosis: selection by body composition. Osteoporos Int. 1996; 6:120–126.

12. Cadarette SM, Jaglal SB, Kreiger N, McIsaac WJ, Darlington GA, Tu JV. Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry. CMAJ. 2000; 162:1289–1294.

13. Richy F, Deceulaer F, Ethgen O, Bruyère O, Reginster JY. Development and validation of the ORACLE score to predict risk of osteoporosis. Mayo Clin Proc. 2004; 79:1402–1408.

14. Koh LK, Sedrine WB, Torralba TP, Kung A, Fujiwara S, Chan SP, et al. A simple tool to identify asian women at increased risk of osteoporosis. Osteoporos Int. 2001; 12:699–705.

15. Park HM, Sedrine WB, Reginster JY, Ross PD. Korean experience with the OSTA risk index for osteoporosis: a validation study. J Clin Densitom. 2003; 6:247–250.

16. Oh SM, Nam BH, Rhee Y, Moon SH, Kim DY, Kang DR, et al. Development and validation of osteoporosis risk-assessment model for Korean postmenopausal women. J Bone Miner Metab. 2013; 31:423–432.

17. Lynn HS, Lau EM, Wong SY, Hong AW. An osteoporosis screening tool for Chinese men. Osteoporos Int. 2005; 16:829–834.

18. Zimering MB, Shin JJ, Shah J, Wininger E, Engelhart C. Validation of a novel risk estimation tool for predicting low bone density in Caucasian and African American men veterans. J Clin Densitom. 2007; 10:289–297.

19. Shepherd AJ, Cass AR, Carlson CA, Ray L. Development and internal validation of the male osteoporosis risk estimation score. Ann Fam Med. 2007; 5:540–546.

20. Adler RA, Tran MT, Petkov VI. Performance of the Osteoporosis Self-assessment Screening Tool for osteoporosis in American men. Mayo Clin Proc. 2003; 78:723–727.

21. Sinnott B, Kukreja S, Barengolts E. Utility of screening tools for the prediction of low bone mass in African American men. Osteoporos Int. 2006; 17:684–692.

22. Lynn HS, Woo J, Leung PC, Barrett-Connor EL, Nevitt MC, Cauley JA, et al. An evaluation of osteoporosis screening tools for the osteoporotic fractures in men (MrOS) study. Osteoporos Int. 2008; 19:1087–1092.

23. Li-Yu JT, Llamado LJ, Torralba TP. Validation of OSTA among Filipinos. Osteoporos Int. 2005; 16:1789–1793.

24. Lee CH, Oh SW, Seung JH, Do HJ, Lym YL, Choi JK, et al. Evaluation of Osteoporosis Self-Assessment Tool Usefulness as a Screening Test for Osteoporosis in Korean Men. Korean J Fam Med. 2009; 30:944–950.

25. Park EJ, Joo IW, Jang MJ, Kim YT, Oh K, Oh HJ. Prevalence of Osteoporosis in the Korean Population Based on Korea National Health and Nutrition Examination Survey (KNHANES), 2008-2011. Yonsei Med J. 2014; 55:1049–1057.

26. MOHW and KCDC. Korea Health Statistics 2010: Korean National Health and Nutrition Examination Survey (KNHANES V-1). Osong: Ministry of Health and Social Welfare and Korea Centers for Disease Control & Prevention;2012.

27. Choi HS, Oh HJ, Choi H, Choi WH, Kim JG, Kim KM, et al. Vitamin D insufficiency in Korea--a greater threat to younger generation: the Korea National Health and Nutrition Examination Survey (KNHANES) 2008. J Clin Endocrinol Metab. 2011; 96:643–651.

28. Hong S, Oh HJ, Choi H, Kim JG, Lim SK, Kim EK, et al. Characteristics of body fat, body fat percentage and other body composition for Koreans from KNHANES IV. J Korean Med Sci. 2011; 26:1599–1605.

29. KCDC. Education and quality control of bone mineral density in the Fourth National Health and Nutrition Examination Survey (KNHANES IV-3). Osong: Korea Centers for Disease Control & Prevention;2009.

30. Kanis JA, Hans D, Cooper C, Baim S, Bilezikian JP, Binkley N, et al. Interpretation and use of FRAX in clinical practice. Osteoporos Int. 2011; 22:2395–2411.

31. Langsetmo L, Hitchcock CL, Kingwell EJ, Davison KS, Berger C, Forsmo S, et al. Physical activity, body mass index and bone mineral density-associations in a prospective population-based cohort of women and men: the Canadian Multicentre Osteoporosis Study (CaMos). Bone. 2012; 50:401–408.

32. Ma L, Oei L, Jiang L, Estrada K, Chen H, Wang Z, et al. Association between bone mineral density and type 2 diabetes mellitus: a meta-analysis of observational studies. Eur J Epidemiol. 2012; 27:319–332.

33. Wu Q, Magnus JH, Liu J, Bencaz AF, Hentz JG. Depression and low bone mineral density: a meta-analysis of epidemiologic studies. Osteoporos Int. 2009; 20:1309–1320.

34. Lee J, Vasikaran S. Current recommendations for laboratory testing and use of bone turnover markers in management of osteoporosis. Ann Lab Med. 2012; 32:105–112.

35. Joo NS, Dawson-Hughes B, Kim YS, Oh K, Yeum KJ. Impact of calcium and vitamin D insufficiencies on serum parathyroid hormone and bone mineral density: analysis of the fourth and fifth Korea National Health and Nutrition Examination Survey (KNHANES IV-3, 2009 and KNHANES V-1, 2010). J Bone Miner Res. 2013; 28:764–770.

36. Kohavi R. A study of cross-validation and bootstrap for accuracy estimation and model selection. California: IJCAI;1995.

37. Hosmer D, Lemeshow S. Applied logistic regression. 2nd ed. New York: Wiley;2000.

38. Pencina MJ, D'Agostino RB Sr, D'Agostino RB Jr, Vasan RS. Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med. 2008; 27:157–172.

39. Maddalozzo GF, Snow CM. High intensity resistance training: effects on bone in older men and women. Calcif Tissue Int. 2000; 66:399–404.

40. Forwood MR, Burr DB. Physical activity and bone mass: exercises in futility? Bone Miner. 1993; 21:89–112.

41. Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr. 2004; 80:1678S–1688S.

42. van Schoor NM, Visser M, Pluijm SM, Kuchuk N, Smit JH, Lips P. Vitamin D deficiency as a risk factor for osteoporotic fractures. Bone. 2008; 42:260–266.

43. Leslie WD, Morin S, Lix LM, Johansson H, Oden A, McCloskey E, et al. Fracture risk assessment without bone density measurement in routine clinical practice. Osteoporos Int. 2012; 23:75–85.