Performance of osteoporosis self-assessment tool in detecting low bone mineral density in menopausal women

Main Article Content

Ignatio Rika Haryono
Nawanto Agung Prastowo


The osteoporosis self-assessment tool (OST) is a simple screening tool to assess risk of osteoporosis and to select high risk women for dual-energy x-ray absorptiometry (DXA) examination. This study aimed to evaluate OST performance in detecting low bone mineral density (BMD) in menopausal women.

A cross-sectional study involving 60 menopausal women aged 50-65 years. The OST score was calculated from: [weight (kg) – age (yr)] x 0.2. Subjects were classified by OST score into low risk (OST ³2) and high risk (OST< 2) groups. BMD was determined by DXA at 3 bone locations (L1-L4, femoral neck, and total hip). DXA T-scores were categorized into: normal BMD (T-score >-1) and low BMD (T-score £-1). Independent t-test was used to compare subject characteristics between OST groups. Diagnostic performance of OST was evaluated by measuring sensitivity, specificity, positive & negative predictive value (PPV, NPV), positive & negative likelihood ratio (PLR, NLR) and receiver-operating characteristic (ROC). Significance was set at p<0.05.

Subject characteristics and BMD between groups were significantly different (p<0.05). Most subjects (44/73.3%) had high risk of low BMD (OST < 2). Low BMD (T score £-1) was found in 43 subjects (71.7%) at L1-L4, 41 subjects (68.3%) at femoral neck, and 37 subjects (61.7%) at total hip. Diagnostic performance of OST was significant at total hip BMD (sensitivity=0.946, AUC=0.777).

We conclude that use of the OST score in menopausal women is effective and has adequate sensitivity and specificity. The highest diagnostic performance of OST is on total hip BMD.

Article Details

How to Cite
Haryono, I. R., & Prastowo, N. A. (2017). Performance of osteoporosis self-assessment tool in detecting low bone mineral density in menopausal women. Universa Medicina, 36(2), 123–130.
Original Articles
Author Biographies

Ignatio Rika Haryono, Department of Physiology, Faculty of Medicine, Indonesia Catholic University of Atma Jaya, Jakarta, Indonesia

Department of Physiology, staff/lecturer

Nawanto Agung Prastowo, Department of Physiology, Faculty of Medicine, Indonesia Catholic University of Atma Jaya, Jakarta, Indonesia

Staf, Department of Physiologi


Choi YJ, Oh HJ, Kim DJ, et al. The prevalence of osteoporosis in Korean adults aged 50 years or older and the higher diagnosis rates in women who were beneficiaries of a national screening program: The Korea National Health and Nutrition Examination Survey 2008-2009. J Bone Miner Res 2012;27:1879-86.

Wright NC, Looker AC, Saag KG, et al. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res 2014; 29:2520-6.

Meiyanti. Epidemiology of osteoporosis in postmenopausal women aged 47 to 60 years. Univ Med 2010;29:169-76.

Montazerifar F, Karajibani M, Alamian S, et al. Age, weight, and body mass index effect on bone mineral density in postmenopausal women. Health Scope 2014;3:e14075. DOI: 10.17795/jhealthscope-14075.

Rexhepi S, Bahtiri E, Rexhepi M, et al. Association of body weight and body mass index with bone mineral density in women and men from Kosovo. Mater Sociomed 2015;27:259-62.

Navarro MC, Sosa M, Saavedra P, et al. Poverty is a risk factor for osteoporotic fractures. Osteoporosis Int 2009;20:393-8.

Romero GT, Rodriguez N, Santana S, et al. Prevalence of osteoporosis, vertebral fractures and hypovitaminosis D in postmenopausal women living in a rural environment. Maturitas 2014;77:282-6.

Pecina JL, Romanovsky L, Merry SP, et al. Comparison of clinical risk tools for predicting osteoporosis in women ages 50-64. J Am Board Fam Med 2016;29:233-9.

Ahmadzadeh A, Emam M, Rajaei A, et al. Comparison of three different osteoporosis risk assessment tools: ORAI (osteoporosis risk assessment instrument), SCORE (simple calculated osteoporosis risk estimation), and OST (osteoporosis self-assessment tool). Med J Islam Repub Iran 2014;28:94.

Rubin KH, Abrahamsen B, Friis-Holmberg T, et al. Comparison of different screening tools (FRAX®, OST, ORAI, OSIRIS, SCORE and age alone) to identify women with increased risk of fracture: a population-based prospective study. Bone 2013;56:16-22.

Nayak S, Edwards DL, Saleh AA, et al. Systematic review and meta-analysis of the performance of clinical risk assessment instruments for screening for osteoporosis or low bone density. Osteoporosis Int 2015;26:1543-54.

Rubin KH, Friis-Holmberg T, Hermann AP, et al. Risk assessment tools to identify women with increased risk of osteoporotic fracture: complexity or simplicity? A systematic review. J Bone Miner Res 2013;28:1701-17.

Chaovisitsaree S, Namwongprom SN, Morakote N, et al. Comparison of osteoporosis self-assessment tool for Asian (OSTA) and standard assessment in menopause clinic, Chiang Mai. J Med Assoc Thai 2007;90:420-5.

Hans DB, Shepherd JA, Schwartz EN, et al. Peripheral dual-energy X-ray absorptiometry in the management of osteoporosis: the 2007 ISCD Official Positions. J Clin Densitometry 2008;11:188-206.

Siris ES, Adler R, Bilezikian J, et al. The clinical diagnosis of osteoporosis: a position statement from the National Bone Health Alliance Working Group. Osteoporos Int 2014; 25:1439–43.

Saraví FD. Osteoporosis self-assessment tool performance in a large sample of postmenopausal women of Mendoza, Argentina. J Osteoporos 2013;

Muslim DAJ, Mohd EF, Sallehudin AY, et al. Performance of osteoporosis self-assessment tool for Asian (OSTA) for primary osteoporosis in post-menopausal Malay women. Malay Orthop J 2012;6:35-9.

Chen H, Zhou X, Fujita H et al. Age-related changes in trabecular and cortical bone microstructure. Int J Endocrinol 2013;

Morin S, Tsang JF, Leslie WD. Weight and body mass index predict bone mineral density and fracture in women aged 40 to 59 years. Osteoporosis Int 2009;20:363-70.

Cao JJ. Effects of obesity on bone metabolism. J Orthop Surg Res 2011;6:30. DOI:10.1186/1749-799X-6-30.

Liu PY, Ilich JZ, Brummel-Smith K, et al. New insight into fat, muscle, and bone relationship in women: determining the threshold at which body fat assumes negative relationship with bone mineral density. Int J Prev Med 2014;5:152-63.

Migliaccio S, Greco EA, Fornari R, et al. Is obesity in women protective against osteoporosis? Diabetes Metab Syndr Obes 2011;4:273-82.

Greco EA, Fornari R, Rossi F, et al. Is obesity protective for osteoporosis? Evaluation of bone mineral density in individuals with high body mass index. Int J Clin Prac 2010;64:817-20.