Towards efficient osteoporosis screening: a simple and practical approach using OSTA and FRAX risk factors

INTRODUCTION: Osteoporosis is a major public health concern, particularly in the aging population, where fragility fractures significantly impact quality of life and mortality. Despite the importance of early detection, screening rates for osteoporosis in Japan remain low. The Osteoporosis Self-Assessment Tool for Asians (OSTA) and Fracture Risk Assessment Tool (FRAX) are noninvasive screening tools. This study aimed to develop an efficient method for screening osteopenia using these tools. MATERIALS AND METHODS: We analyzed data from 1060 Japanese women aged 40-74 years from the Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study. The OSTA and FRAX scores, as well as individual FRAX risk factors, were assessed for their ability to detect osteopenia. As FRAX score calculations are not publicly available, we evaluated the discriminative ability of the seven risk factors individually. Prior fragility fractures were deemed the most critical, and all 64 possible combinations of the remaining six risk factors were analyzed. RESULTS: OSTA had the highest discriminative ability (AUC = 0.81), followed by FRAX-Hip (AUC = 0.79) and FRAX-Major (AUC = 0.77). The sensitivity and specificity of OSTA ≤ -1 were 83.7% and 62.6%, respectively. The most effective criterion was OSTA ≤ -1 or at least one FRAX risk factor, achieving a sensitivity of 90.4%, specificity of 47.2%, and positive predictive value of 63.3%. CONCLUSION: A simple, noninvasive osteopenia screening method combining OSTA ≤ -1 and FRAX risk factors identified at-risk individuals effectively. This approach could enhance osteoporosis screening in Japan and facilitate early intervention and fracture prevention.