5.
Simulated Screening for Osteoporosis in 10,000 Men Aged 50 Years and Older: 10-Year Hip Fracture Outcomes
| Age-Groups, Years | |||||||||
| Variables | 50–54 | 55–59 | 60–64 | 65–69 | 70–74 | 75–79 | 80–84 | 85–89 | Overall |
| Base/case assumptions* | |||||||||
| Fracture risk27 | 0.034 | 0.057 | 0.091 | 0.133 | 0.215 | 0.328 | 0.362 | 0.333 | 0.135 |
| Osteoporosis prevalence (NHANES III) | 0.007 | 0.034 | 0.036 | 0.049 | 0.051 | 0.094 | 0.119 | 0.257 | 0.048 |
| Relative risk for hip fracture with treatment18 | 0.63 | 0.63 | 0.63 | 0.63 | 0.63 | 0.63 | 0.63 | 0.63 | 0.63 |
| Adherence to treatment, proportion18 | 0.70 | 0.70 | 0.70 | 0.70 | 0.70 | 0.70 | 0.70 | 0.70 | 0.70 |
| Results per 10,000 men | |||||||||
| Predicted cases of osteoporosis, n | 70 | 340 | 360 | 490 | 510 | 940 | 1,190 | 2,570 | 480 |
| MORES screen: true positive | 65 | 316 | 335 | 456 | 474 | 874 | 1,107 | 2,390 | 446 |
| MORES screen: false negative | 5 | 24 | 25 | 34 | 36 | 66 | 83 | 180 | 34 |
| MORES screen: true negative | 5,859 | 5,699 | 5,688 | 5,611 | 5,599 | 5,345 | 5,198 | 4,384 | 5,617 |
| MORES screen: false positive | 4,071 | 3,961 | 3,952 | 3,899 | 3,891 | 3,715 | 3,612 | 2,046 | 3,903 |
| Referred for DXA (TP + FP), n | 4,136 | 4,277 | 4,287 | 4,355 | 4,365 | 4,589 | 4,719 | 5,436 | 4,350 |
| Predicted hip fractures: screened MORES:DXA | |||||||||
| Predicted hip fractures: true positive | 1.64 | 13.36 | 22.58 | 44.91 | 75.56 | 212.47 | 296.86 | 589.76 | 44.72 |
| Predicted hip fractures: false negative | 0.17 | 1.36 | 2.29 | 4.56 | 7.68 | 21.58 | 30.15 | 59.91 | 4.54 |
| Predicted hip fractures: total | 1.81 | 14.71 | 24.87 | 49.47 | 83.24 | 234.05 | 327.02 | 649.67 | 49.26 |
| Predicted hip fractures: unscreened | 2.38 | 19.38 | 32.76 | 65.17 | 109.65 | 308.32 | 430.78 | 855.81 | 64.90 |
| NNS MORES:DXA | 7,216 | 917 | 544 | 278 | 166 | 62 | 46 | 27 | 279 |
| Universal DXA screen | |||||||||
| Fracture RX | 1.76 | 14.36 | 24.28 | 48.29 | 81.25 | 228.47 | 319.21 | 643.16 | 48.09 |
| Fracture no RX | 2.38 | 19.38 | 32.76 | 65.17 | 109.65 | 308.32 | 430.78 | 855.81 | 64.90 |
| NNS universal DXA | 16,223 | 1,992 | 1,179 | 592 | 352 | 125 | 90 | 45 | 595 |
* Formulas used in calculations are available upon request from the authors.
DXA = dual energy x-ray absorptiometry; FP = false positive; MORES = Male Osteoporosis Risk Estimate Score; NHANES = National Health and Nutrition Examination Survey; NNS = number needed to screen; RX = diagnosis of osteoporosis and treatment with bisphosphonate therapy; no RX = diagnosis of osteoporosis and no treatment; TP = true positive.