Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.
On March 18, 2025, we reported on a study published in JAMA Network Open that was designed to examine the performance of osteoporosis risk assessment tools recommended by the US Preventive Services Task Force in identifying the presence of osteoporotic bone mineral density (BMD) in younger postmenopausal women.
The study
Researchers conducted a cross-sectional clinical trial using data from the Women’s Health Initiative Bone Density Substudy, which was conducted at 3 clinical centers in the US. Participants (n=6067) were healthy postmenopausal women aged 50 to 64 years with BMD measurements evaluated using the following 3 risk prediction tools:
Osteoporosis Risk Assessment Instrument (ORAI)
Osteoporosis Index of Risk (OSIRIS)
Osteoporosis Self-Assessment Tool (OST)
Researchers measured BMD using dual-energy x-ray absorptiometry (DXA), and defined osteoporosis as a T-score of –2.5 or lower at the femoral neck, total hip, or lumbar spine.
The findings
All 3 tools exhibited an area under the receiver operating curve (AUC) below 0.7, the threshold for an assessment tool to be considered an “acceptable” discriminator. The OSIRIS had the highest AUC for predicting femoral neck osteoporosis (AUC = 0.83), followed by the OST (AUC = 0.818) and the OSIRIS (AUC = 0.805).
When guideline-recommended cutoff scores for predicting osteoporosis for each tool were applied, all demonstrated low sensitivity and moderate specificity. Specifically, the OSIRIS had a sensitivity of 37.8%, a specificity of 88.8%, and an AUC of 0.633. The OSIRIS had a sensitivity of 53.3%, a specificity of 79.4%, and an AUC of 0.663. The OST had a sensitivity of 62.4%, a specificity of 68.5%, and an AUC of 0.654. All 3 tools were categorized as having poor to fair discrimination, with AUCs between 0.5 and 0.7.
Authors' comments
"Screening is essential to reducing individual and societal burden of osteoporosis and related fractures, and this study showed a gap in identifying younger postmenopausal women using common clinical risk factors."
