Validation of the Osteoporosis SelfAssessment Tool in Men with Rheumatoid Arthritis - PowerPoint PPT Presentation

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Validation of the Osteoporosis SelfAssessment Tool in Men with Rheumatoid Arthritis

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Although more common in women, men suffer from fragility. fractures ... tool originally developed to identify Asian women at risk for. osteoporosis. Background ... – PowerPoint PPT presentation

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Title: Validation of the Osteoporosis SelfAssessment Tool in Men with Rheumatoid Arthritis


1
Validation of the Osteoporosis Self-Assessment
Tool in Men with Rheumatoid Arthritis
  • Justin Peng MD, John S. Richards MD, Gail Kerr MD
  • Georgetown University and VAMC, Washington DC

2
Purpose
  • The Osteoporosis Self-Assessment Tool (OST) is a
    simplified instrument that incorporates weight
    and age to predict patients at risk for
    osteoporosis.
  • We tested the validity and predictive value of
    the OST index in a male cohort of patients with
    rheumatoid arthritis.

3
Background - Osteoporosis
Osteoporosis is the end result of years of bone
loss, which is always due to a mismatch between
bone resorption and bone formation.
4
Background
  • Rheumatoid Arthritis (RA) is a major risk factor
    for
  • Osteoporosis.
  • Although more common in women, men suffer from
    fragility
  • fractures and have a worse outcome.
  • Indications for dual energy x-ray absorptiometry
    (DXA) in
  • males are vague and based on expert opinion
    rather than
  • clinical trials.
  • The Osteoporosis Self-Assessment Tool (OST) is a
    screening
  • tool originally developed to identify Asian
    women at risk for
  • osteoporosis.

5
Background
  • OST Index Weight (Kg) Age x 0.2 (remove
  • decimal)
  • OST Risk Categories
  • gt 4 Low Risk
  • -1 to 3 Moderate Risk
  • lt -2 High Risk
  • This study evaluates the utility of the OST Index
    to
  • predict osteoporosis/osteopenia in a cohort
    of male
  • subjects with RA

6
Methods
  • The Veterans Affairs Rheumatoid Arthritis
    Registry (VARA) is a
  • database of veterans with RA, 90 of whom are
    male.
  • Male patients in the VARA database who had a dual
    energy x-
  • ray absorptiometry (DXA) scan were included in
    the study.
  • Bone mineral density (BMD) results for each
    subject were
  • standardized using published formulas and
    T-scores calculated
  • T-scores were classified as normal, osteopenia
    and
  • osteoporosis according to the WHO criteria
  • The OST index was calculated for each subject at
    the time of
  • DXA.

7
Methods
  • Sensitivity, specificity, and predictive values
    of the different OST categories for low BMD were
    calculated
  • The association of the OST index with low BMD was
    adjusted for measures of disease activity /
    severity and select comorbid diseases using
    separate multivariable logistic regression model.

8
Statistics
  • Sensitivity
  • The probability that a diseased patient has a
    positive test result
  • Specificity
  • The probability that a nondiseased person will
    have a negative test result
  • Positive Predictive Value
  • The probability that a patient with a positive
    test result has the disease
  • Negative Predictive Value
  • The probability that a patient with a negative
    test result is disease free

9
Statistics
PPV A / (A B) NPV D / (C D)
Sensitivity A / (A C) Specificity D / (B
D)
10
Results
  • 264 of 780 males in the cohort had a DXA
  • Mean age was 66.2 and 81 were Caucasians
  • Subjects with DXA were more likely to smoke (p lt
  • 0.019)
  • No difference in demographics, RA disease
  • duration, activity or severity and comorbid
    diseases
  • in those with DXA vs. those without DXA

11
Results
Table 1 - Distribution of OST Index in Male VARA
Patients
12
Results
Figure 1 Predictive Value of The Different OST
Risk Groups for Predicting Low BMD
13
Table 2 - Univariate Associations of OST Index
with Reduced BMD (Osteopenia/Osteoporosis)
Subgroup Analysis
14
Table 3 - Multivariable Associations of OST Index
with Reduced BMD (Osteopenia/Osteoporosis)
Adjusting for Measures of Disease
Activity/Severity
15
Table 4 - Multivariable Associations of OST Index
with Reduced BMD (Osteopenia/Osteoporosis)
Adjusting for Select Comorbidity
16
Limitations
  • Possible selection bias with DXA ascertainment
  • Limited sample sizes for subgroup comparisons
    (particularly for younger patients, never
    smokers, and Non-Hispanic Blacks)

17
Conclusions
  • Although lacking sensitivity in this
    retrospective study of male
  • RA patients, a High Risk OST Index was
    predictive of low BMD
  • The association of the OST Index with low BMD
    appeared to
  • be consistent across subgroups, although the
    association was
  • attenuated in younger men and never smokers
  • The association of the OST Index with low BMD was
  • independent of measures of disease activity /
    severity and the
  • presence of select comorbid conditions
  • A prospective trial in a larger cohort is needed
    to assess the
  • predictive value of the OST Index in
    inflammatory rheumatic
  • diseases and if ethnic or age specific cutoffs
    are required

18
References
  • Laan RF, van Riel Pl, van de Putte LB et al Ann
    Intern Med 1993119963-8
  • Poor G , Atkinson EJ, Lewallen DG et al.
    Age-related hip fractures in men clinical
    spectrum and short term outcome. Osteoporosis
    Int19955419-26
  • Binkley N, Bilezikian JP, Kendler DL et al J Clin
    Densitom 200694-14
  • Koh LK, Ben Sedrine W, Torralba TP et al.
    Oseoporosis Int. 20011212699-705
  • Looker AC, Wahner HW, Dunn WL et al. Osteoporosis
    Int 19988468-489

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