Are other feasible options available for screening of risk assessment of osteoporosis in postmenopausal women at community level in Southern Coastal India

Gowry Reddy, Priya Rathi, Unnikrishnan B., Surendra Kamath, Kalpita Shringapure


Background: Osteoporosis is a chronic debilitating condition which exhibits iceberg phenomenon. Identification at an early stage of disease will enable preventive measures to reduce the incidence of disease and complications. Owing to the cost of diagnostic test, this study, various screening tools such as WHO fracture risk assessment tool, osteoporosis self-assessment tool for Asians, simple calculated osteoporosis risk estimation and osteoporosis risk assessment instrument   have been used for assessment, in order to screen postmenopausal women in the preliminary stages.

Methods: A facility-based cross-sectional study was conducted among 107 postmenopausal women carried over a period of five months.

Results: Prevalence of osteoporosis and osteopenia was 24.3% and 69.2%. The area under the curve for osteoporosis self-assessment tool for Asians (OSTA), simple calculated osteoporotic risk estimation (SCORE) and osteoporotic risk assessment instrument (ORAI) was 0.731, 0.407 and 0.172 respectively. OSTA proved to be effective in differentiating normal BMD from low BMD score (i.e., osteopenia and osteoporosis) with a cut off of 1.1, SCORE to be more effective in screening osteoporosis than the other tools because it had a higher positive probability with a cut off 22.  FRAX tool predicted probability of five and three percent probability of major fracture and hip fracture risk in ten years

Conclusions: Various tools assessed in the studies can be utilized at community level for identifying high risk women in post-menopausal stage but with different cut offs. This will reduce the cost of screening and also facilitate non pharmacological measures to reduce the progression of disease.


Osteoporosis, Screening tools, Bone densitometry, Postmenopausal women

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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;162:1289–94.

RudB, Jensen JE, Mosekilde L, Nielsen SP, Hilden J, Abrahamsen B. Performance of four clinical screening tools to select peri- and early postmenopausal women for dual X-ray absorptiometry. Osteoporos Int. 2005;16(7):764-72.

Kedros JG, Sybrowsky CL, Stoddard GJ. The osteoporosis self-assessment screening tool: a useful tool for the orthopaedic surgeon. J Bone Joint Surg [AM]. 2007;89(4):765-72.

Ribot C, Pouilles JM, Bonneau M, Tremollieres F (1992) Assessment of the risk of post-menopausal osteoporosis using clinical factors. Clin Endocrinol. 1992;36:225–8.

Kataria S, Pareek P, Dadhich A, Kataria K, Bhati M. The Effect of Body Mass Index on Bone Mineral Density in pre and postmenopausal women of Western Rajasthan population. Int J Biol Med Res. 2012;3(3):1899-901.

Khadilkar AV, Mandlik RM. Epidemiology and treatment of osteoporosis in women: an Indian perspective. International J Women’s Health. 2015;7:841-50.

Jain V, Agrawal BK, Varshney A. Prediction of bone mineral density by age, body mass index and menopausal status in middle socioeconomic status women of urban kolar region of Bhopal. IOSR J Dental Medical Sci. 2013;12(3):17-21.

Sharma S, Khandelwal S. Effective risk assessment tools for osteoporosis in the Indian menopausal female. J Midlife Health. 2010;1(2):79-85.

DEXA Bone Density Scan: Advantages and Disadvantages of DEXA Scan. Available at: Accessed on 18 July 2018.

Hashmi FR, Elfandi KO. Heel Ultrasound Scan in Detecting Osteoporosis in Low Trauma Fracture Patients. Orthopedic Reviews. 2016;8(2):6357.

Miller PD, Zapalowski C, Kulak CAM, et al. Bone densitometry: the best way to detect osteoporosis and to monitor therapy. J Clin Endocrin Metab. 1999;84:1867–71.

Perez D, Marin AF, Vila J, Abizanda M, Cervera A, Carbonell C, et al. Evaluation of calcaneal quantitative ultra- sound in a primary care setting as a screening tool for osteoporosis in post- menopausal women. J Clin Densitom. 2003;6:237.

Langton CM, Ballard PA, Bennett DK, Purdie DW. A comparison of the sensitivity and specificity of calcaneal ultrasound measurements with clinical criteria for bone densitometry (DEXA) referral. Clin Rheumatol. 1997;16:117-8.

Kala BS. Assessment of Risk for Osteoporosis Among Postmenopausal Women. . International Journal of Pharma and Bio Sciences. 2016;7(3):1000–4.

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(8): 699-705.

Rao H, Rao N. Sharma LR. A clinical study of boné mineral density using heel ultra-densitometer in Southern Maharashtra. Indian J Orthop. 2003;37:9.

Geusens P, Hochberg MC, van der Voort DJ, et. al. Performance of risk indices for identifying low bone density in postmenopausal women. Mayo Clin Proc. 2002;77(7):629-37.

Singh T, Sharma S, Nagesh S. Socio-economic status scales updated for 2017. Int J Res Med Sci. 2017;5:3264-7.

BMI Classification: Global Database on Body Mass Index. [Internet]. WHO. 2006. Available at: Accessed on 18 July 2018.

Muslim DAJ, Mohd EF, Sallehudin AY, Tengku Muzaffar TMS, Ezane AM. Performance of Osteoporosis Self-Assessment Tool for Asian (OSTA) for Primary Osteoporosis in Post-menopausal Malay Women. Malaysian Orthopaedic J. 2012; 6(1): 35-9.

Chowdhury, B. Assessment of bone mineral density and osteoporosis status in elderly Indian population. International J Clin Experimental Physiol. 2014;1(3): 232-4.

Mishra SK, Trivedi A, Neelkanth N, Trivedi A. A camp based screening ofBMD in medical students: early detection of an iceberg phenomenon. Int J Res Med Sci. 2018;6:1273-6.

Chen SJ, Chen YJ, Cheng CH, Hwang HF, Chen CY, Lin MR. Comparisons of Different Screening Tools for Identifying Fracture/Osteoporosis Risk Among Community-Dwelling Older People. Medicine (Baltimore). 2016;95(20):3415.

Crandall CJ, Larson J, Gourlay ML, Donaldson MG, LaCroix A, Cauley JA, et al. Osteoporosis screening in postmenopausal women 50 to 64 years old: comparison of US Preventive Services Task Force strategy and two traditional strategies in the Women's Health Initiative. J Bone Miner Res. 2014;29(7):1661-6.

Pecina JL, Romanovsky L, Merry SP, Kennel KA, Thacher TD. Comparison of Clinical Risk Tools for Predicting Osteoporosis in Women Ages 50-64. J Am Board Fam Med. 2016;29(2):233-9.

Cherian KE, Kapoor N, Shetty S, Naik D, Thomas N, Paul TV. Evaluation of Different Screening Tools for Predicting Femoral Neck Osteoporosis in Rural South Indian Postmenopausal Women. J Clin Densitom. 2018;21(1):119-24.

Yang Y, Wang B, Fei Q, Meng Q, Li D, Tang H et al. Validation of an osteoporosis self-assessment tool to identify primary osteoporosis and new osteoporotic vertebral fractures in postmenopausal Chinese women in Beijing. BMC Musculoskelet Disord. 2013;14:271.

Panichyawat N, Tanmahasamut P. Comparison of OSTA index and KKOS scoring system for prediction of osteoporosis in postmenopausal women who attended Siriraj Menopause Clinic. J Med Assoc Thai. 2012;95(11):1365-71.