Performance of the osteoporosis self-assessment tool in ruling out low bone mineral density in postmenopausal women: A systematic review

The Osteoporosis Self-Assessment Tool (OST) is a simple test that may be of clinical value to rule-out low bone mineral density. We performed a systematic review to assess its performance in postmenopausal women. We included 36 studies. OST performed moderately in ruling-out femoral neck T-score <= - 2.5, but poorly in ruling-out lumbar spine T-score <= - 2.5. Methodological study quality was generally low. Introduction The Osteoporosis Self-Assessment Tool ( OST) is a simple clinical decision rule based on age and weight that may be of clinical value to rule-out low bone mineral density (BMD). Our aim was to systematically assess the performance of OST in postmenopausal women. Methods We searched PubMed, Embase, Web of Science, citation lists and conference proceedings for studies evaluating OST using dual X-ray absorptiometry (DXA) as reference test to measure BMD. We evaluated methodological quality using the QUADAS checklist. Our main outcome was the likelihood ratio of a negative OST result (LR-). Results OST performed moderately in ruling-out femoral neck T-score <= - 2.5 in whites, summary LR- (sLR-) 0.19 (95% CI, 0.17-0.21) and between-study heterogeneity was low (I-2= 7%). The corresponding performance in Asians was similar, sLR- 0.19 ( 0.14-0.28), but there was considerable heterogeneity (I-2= 64%). OST performed poorly in ruling-out lumbar spine T-score <= - 2.5 in whites and Asians, sLR- 0.43 (0.31-0.59) and 0.32 (0.28-0.38), respectively. The performance in ruling-out T-score <= - 2.0 in whites was poor regardless of region ( sLR- >= 0.28). Methodological study quality was generally low. Conclusions The clinical usefulness of OST is uncertain. OST could be useful for ruling-out femoral neck T-score <= - 2.5, but confirmatory high-quality studies are needed.