An assessment of the new "SCORE" index as a predictor of osteoporosis in women

Background: The study was done to determine whether the new SCORE (Simple Calculated Osteoporosis Risk Estimation) index might reduce the utilization of bone mineral density (BMD) measurement. Methods: 989 consecutive patients who were referred by a range of physicians for BMD assessments at one of two clinics had a SCORE index constructed. Approximately 95% of the subjects were Caucasian. The index is based on only 6 factors: age, previous fractures, rheumatoid arthritis, estrogen use, weight, and race. Results: All but 1 (0.1%) of those with a femoral neck BMD T-score of < -2.5 had an abnormal SCORE index. However, its specificity was relatively low, since two thirds of those individuals also with an abnormal index had a T-score of > -2.5. One percent false negatives were also seen in the lumbar spine. Conclusion: The SCORE index correctly predicted those individuals who did not have an osteoporotic T-score. It was of the most Value in the <60 age group. Discussion: The precise role of BMD measurement in the assessment and management of individuals possibly at risk for osteoporosis remains controversial. Our results suggest that the prior use of the SCORE index by the referring physicians to screen the patients sent for BMD measurement would have allowed them to exclude over 20% of the patients referred for assessment, and therefore reduce the need and cost of BMD measurement. The proportion of individuals who had a normal SCORE index, and would have been screened out, was 43% in the under 60 year age group, but in the 65 and over age group it provided no additional information to help with, for example, the National Osteoporosis Foundation (NOF) guidelines.