Validation and comparative evaluation of four osteoporosis risk indexes in Moroccan menopausal women

INTRODUCTION: Measuring bone mineral density (BMD) is a widely accepted strategy for identifying subjects with an increased risk of fracture. However, because of limited availability of BMD technology in some communities and cost considerations, it has been proposed that BMD measurements be targeted to subjects with risk factors for osteoporosis. Recently, many risk assessment indices have been developed to identify women who are more likely to have low BMD and thus undergo BMD testing. The objective of this study was to compare the performance of four risk indices for osteoporosis in white women in Morocco. METHODS: We analysed in an epidemiological cross-sectional study the records for 986 postmenopausal white Moroccan women seen at an out-patient rheumatology centre. Four osteoporosis risk index scores were compared to bone density T-scores. The ability of each risk index to identify women with low BMD (T-score<−2.0) or osteoporosis (T<−2.5) was evaluated. RESULTS: Using an Osteoporosis Self-Assessment Tool (OST) score<2 to recommend DXA referral, we found that sensitivity ranged from 61% at the lumbar spine to 85% at the total hip to detect BMD T-scores of −2.5, and specificity ranged from 62% at the lumbar spine to 67% at the total hip. The negative predictive value was high at all skeletal sites (79–98%), demonstrating the usefulness of the OST to identify patients who have normal BMD and should not receive DXA testing. All risk indices performed similarly and showed better results in identifying women with osteoporosis or low BMD based on hip measurement. CONCLUSIONS: This is the first study that validated several risk osteoporosis indexes in Moroccan women. The performance of these risk indices among women in Morocco was similar to that reported earlier for other samples in Asian countries, the US, and Belgium. The OST and other risk indices are effective and efficient tools to help target high-risk women for DXA measurement.