Context: Osteoporosis-related fractures are a significant problem for men as well as women;however, osteoporotic fractures in men are associated with higher mortality. Recent studies strongly suggest that treatment of osteoporosis in men should result in reductions in fractures to similar rates observed in women. The lack of a simple and efficient approach to identify men at risk for osteoporosis is one of the barriers to reducing adverse outcomes associated with osteoporosis-related fractures in men. The research proposed in this grant application will address this issue by evaluating the ability of the Male Osteoporosis Risk Estimation Score (MORES) to identify the men most likely to benefit from bone mineral density testing in a primary care setting. Objectives: Our long-term research goal is to improve screening for men who may be at risk for osteoporosis, implement effective interventions, and ultimately reduce mortality and morbidity associated with osteoporotic fractures. The primary objective of this project is to evaluate the use of a new clinical index, the MORES, to assess the risk of osteoporosis in men seeking care in an ambulatory primary care setting. The MORES is a simple, summative score of weighted values for risk factors for osteoporosis that includes age, weight, and history of chronic obstructive pulmonary disease.
Two specific aims were developed to accomplish the objective: (1) validate the MORES as a clinical index to determine the risk of osteoporosis in men attending primary care outpatient clinics;and (2) evaluate the effectiveness of the MORES for identifying risk of osteoporosis at the spine, hip, and hip and/or spine combined in men attending primary care outpatient clinics by analyzing the number needed-to-screen (NNS) to prevent one additional hip fracture. Design and Setting: This is a cross-sectional sample of men aged 60 years and older attending primary care clinics. Methods: Subjects will complete a research questionnaire, undergo bone mineral density testing by dual energy absorptiometry (DXA), and be classified as having osteoporosis or not. The MORES will be used to classify men into screen and do not screen categories. Results will be used to construct contingency tables to calculate sensitivity and specificity;the results will be compared to previously reported values and measures of the area under the receiver operator characteristic curve. Performance will be assessed for hip, spine, and combined sites. From the observed data and from using published estimates of prevalence and fracture rates, the NNS will be calculated to assess the effectiveness of the MORES followed by DXA to screen men for osteoporosis. Implications: Validation of the MORES in a primary care setting will provide evidence that a two-step approach to screening men for osteoporosis could lead to more informed decisions regarding bone density testing and treatment of men with osteoporosis and may help to reduce mortality and morbidity of osteoporosis-related fractures. These findings will add to the literature on translating research into primary care practice and may potentially affect policy decisions on screening men for osteoporosis.
The proposed project addresses an increasingly important issue related to diagnosing osteoporosis in men prior to experiencing a fracture. The results of this study will provide evidence for agencies such as the United States Preventive Services Task Force to offer recommendations and/or guidelines regarding screening for osteoporosis in men. The public will benefit by having a simple and efficient way to diagnose previously undetected and asymptomatic osteoporosis and through treatment, prevent the disability associated with fractures of the hip and spine.
| Cass, Alvah R; Shepherd, Angela J (2013) Validation of the Male Osteoporosis Risk Estimation Score (MORES) in a primary care setting. J Am Board Fam Med 26:436-44 |
