Development of Osteoporosis Screening Algorithm for Population Aged 50 Years and above in Klang Valley, Malaysia
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Anthropometric and Bone Mineral Density (BMD) Measurement
2.3. Statistical Analysis
3. Results
3.1. Model Development
3.2. Diagnostic Performance of Algorithms and Comparison with OSTA
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Inclusion Criteria | Exclusion Criteria |
---|---|
Malaysians | Diagnosed with bone diseases (Paget’s disease, osteogenesis imperfect, osteomalacia, rickets). |
Residing in Klang Valley, Malaysia | Diagnosed with conditions that alter bone metabolism (hypo/hypercalcemia, hypo/hyperthyroidism, hypo/hypergonadism). |
No apparent risk of osteoporosis | Receiving therapeutic agents (thiazide diuretics, glucocorticoids, thyroid supplements, anticonvulsants, antidepressants and osteoporosis treatment agents etc.) that alter bone metabolism. |
Having mobility problems, requiring a walking aid, fractured six months prior to the screening date, having metal implants at the site of scan. | |
Suffered a low impact fracture after the age of 50 years. |
Variable of Interest | Categories | Men (n = 303) | Women (n = 304) | Overall (n = 607) | |||
---|---|---|---|---|---|---|---|
Mean (SD) | Median (IQR) | Mean (SD) | Median (IQR) | Mean (SD) | Median (IQR) | ||
Age (years) | 61.98 (6.78) | 62.00 (10.0) | 59.73 (6.51) | 59.00 (9.00) | 60.85 (6.74) | 60.00 (9.00) | |
Age of menarche (years) | - | - | 13.27 (1.85) | 13.00 (2.00) | 13.27 (1.85) | 13.00 (2.00) | |
Age of menopause (years) | - | - | 44.01 (18.17) | 51.00 (5.00) | 44.01 (18.17) | 51.00 (5.00) | |
Years since menopause (years) | - | - | 8.41 (7.5) | 7.00 (11.00) | 8.41 (7.5) | 7.00 (11.00) | |
Body Anthropometry | Weight (kg) | 69.74 (9.97) | 68.90 (13.1) | 60.25 (11.46) | 59.50 (13.20) | 64.99 (11.74) | 64.30 (15.40) |
Height (m) | 166.02 (10.35) | 166.50 (7.80) | 154.21 (5.73) | 153.90 (7.30) | 160.10 (10.23) | 160.80 (13.10) | |
BMI (kg/m2) | 25.14 (3.46) | 24.80 (4.30) | 25.34 (4.71) | 24.75 (6.0) | 25.24 (4.13) | 24.80 (4.90) | |
Waist circumference (cm) | 88.95 (10.76) | 88.60 (13.00) | 83.24 (11.40) | 83.00 (13.00) | 86.09 (11.44) | 86.00 (12.00) | |
Bone Mineral Density | Lumbar spine (g/cm2) | 0.99 (0.19) | 1.00 (0.20) | 0.87 (0.15) | 0.87 (0.20) | 0.93 (0.18) | 0.92 (0.22) |
Left hip (g/cm2) | 0.91 (0.13) | 0.91 (0.18) | 0.81 (0.12) | 0.81 (0.15) | 0.86 (0.14) | 0.86 (0.17) | |
Demography and BMI Status | number (percentage; %) | ||||||
Age Range (years) | 50–59 | 116 (38.3) | 162 (53.3) | 278 (45.8) | |||
60–69 | 138 (45.5) | 114 (37.5) | 252 (41.5) | ||||
>70 | 49 (16.2) | 28 (9.2) | 77 (12.7) | ||||
Ethnics | Malay | 114 (37.6) | 124 (40.8) | 239 (39.2) | |||
Chinese | 156 (51.5) | 148 (48.7) | 304 (50.1) | ||||
Indians/others | 33 (10.9) | 21 (10.5) | 65 (10.7) | ||||
Marital Status | Single | 7 (2.3) | 25 (8.2) | 32 (5.3) | |||
Married | 296 (97.7) | 279 (91.8) | 575 (94.7) | ||||
Nature of Occupation | Manual | 13 (4.3) | 10 (3.3) | 23 (3.8) | |||
Sedentary | 290 (95.7) | 294 (96.7) | 584 (96.2) | ||||
Estimated Monthly Income | B40 (<RM 7640) | 278 (91.7) | 292 (96.1) | 570 (93.9) | |||
M40 (RM 7640–RM 15,159) | 25 (8.3) | 12 (3.9) | 37 (6.1) | ||||
Highest Education Level | No formal education and Primary school | 29 (9.6) | 30 (9.9) | 59 (9.7) | |||
Secondary school | 130 (42.9) | 165 (54.3) | 295 (48.6) | ||||
Certificate/diploma | 66 (21.8) | 56 (18.4) | 122 (20.1) | ||||
University degree or above | 78 (25.7) | 53 (17.4) | 131 (21.6) | ||||
Parity | Nulliparous | - | 49 (16.1) | 49 (16.1) | |||
1–3 Pregnancies | - | 131 (43.1) | 131 (43.1) | ||||
More than 3 Pregnancies | - | 124 (40.8) | 124 (40.8) | ||||
Underweight (<18.5 kg/m2) | 25 (8.3) | 34 (11.2) | 59 (9.7) | ||||
BMI Classification | Normal (18.5–24.9 kg/m2) | 145 (47.9) | 135 (44.4) | 280 (46.1) | |||
Overweight (>25 kg/m2) | 133 (43.9) | 135 (44.4) | 268 (44.2) | ||||
Lifestyle | number (percentage; %) | ||||||
Regular Dairy Product Intake | Yes | 80 (26.4) | 138 (45.4) | 218 (35.9) | |||
No | 223 (73.6) | 166 (54.6) | 389 (64.1) | ||||
Regular Calcium Supplement Users | Yes | 34 (11.2) | 65 (21.4) | 99 (16.3) | |||
No | 269 (88.8) | 239 (78.6) | 508 (83.7) | ||||
Regular Coffee/Tea Consumption | Yes | 38 (12.5) | 76 (25.0) | 114 (18.8) | |||
No | 265 (87.5) | 228 (75.0) | 493 (81.2) | ||||
Regular Alcohol Intake | Yes | 66 (21.8) | 14 (4.6) | 80 (13.2) | |||
No | 237 (78.2) | 290 (95.4) | 527 (86.8) | ||||
Smoking | Yes | 126 (41.6) | 6 (2.0) | 132 (21.7) | |||
No | 177 (58.4) | 298 (98.0) | 475 (78.3) | ||||
Physical Activity | Inactive (<600 MET/min) | 126 (41.6) | 152 (50.0) | 278 (45.8) | |||
Active (>600 MET/min) | 177 (58.4) | 152 (50.0) | 329 (54.2) | ||||
Fracture History & Bone Health Status | number (percentage; %) | ||||||
History of Fracture | Yes | 18 (5.9) | 14 (4.6) | 32 (5.3) | |||
No | 285 (94.1) | 290 (95.4) | 575 (94.7) | ||||
Osteoporosis Self-Assessment Tool for Asians | Low risk | 249 (82.2) | 202 (66.4) | 451 (74.3) | |||
Moderate risk | 52 (17.2) | 81 (26.6) | 133 (21.9) | ||||
High risk | 2 (0.7) | 21 (6.9) | 23 (3.8) | ||||
Bone Health Status | Normal (T-score > –1.0) | 172 (56.8) | 94 (30.9) | 266 (43.8) | |||
Osteopenia (T-score ≤–1 and > –2.5) | 101 (33.3) | 149 (49.0) | 250 (41.2) | ||||
Osteoporosis (T-score ≤–2.5) | 30 (9.9) | 61 (20.1) | 91 (15.0) |
Variables | Odds Ratio (OR) | 95% CI for OR | B | p-Value | |
---|---|---|---|---|---|
Lower | Upper | ||||
Men | |||||
Age | 1.282 | 1.088 | 1.510 | 0.249 | 0.003 |
Body weight | 0.711 | 0.599 | 0.844 | –0.341 | <0.001 |
Physical activity | 0.007 | <0.001 | 0.105 | –4.93 | <0.001 |
Active vs Inactive (ref.) | |||||
Constant of the model | - | - | - | 3.009 | 0.593 |
Women | |||||
Age | 1.124 | 1.064 | 1.187 | 0.117 | <0.001 |
Body weight | 0.875 | 0.836 | 0.917 | –0.133 | <0.001 |
Monthly income | 14.978 | 3.643 | 61.577 | 2.707 | <0.001 |
B40 vs. M40 (ref.) | |||||
Constant of the model | - | - | - | –1.427 | 0.495 |
Sex | Cut-off Value | Sensitivity (%) | 95% CI | Specificity (%) | 95% CI | J | AUC | 95% CI | p-Value |
---|---|---|---|---|---|---|---|---|---|
Men | ≥0.00120 | 73.3 | 54.1–87.7 | 67.8 | 62.7–85.5 | 0.411 | 0.705 | 0.608–0.803 | <0.001 |
Women | ≥0.161 | 75.4 | 61.9–73.3 | 74.5 | 68.5–79.8 | 0.499 | 0.749 | 0.679–0.820 | <0.001 |
Screening Tool | Cut-off Value | Sensitivity (%) | Specificity (%) | AUC | 95% CI | p-Value |
---|---|---|---|---|---|---|
Men | ||||||
New algorithm | ≥0.00120 | 73.3 | 67.8 | 0.705 | 0.608–0.803 | <0.001 |
OSTA (original cut-off) [8] | < –4 | 0 | 99.4 | 0.497 | 0.393–0.601 | 0.957 |
OSTA (modified cut-off) [8] | ≤1.8 | 81.3 | 61.4 | 0.699 | 0.610–0.787 | <0.001 |
Women | ||||||
New algorithm | ≥0.161 | 75.4 | 67.8 | 0.749 | 0.679–0.820 | <0.001 |
OSTA (original cut-off) [8] | < –4 | 20.3 | 97.6 | 0.587 | 0.504–0.669 | 0.027 |
OSTA (modified cut-off) [8] | ≤0.8 | 81.5 | 55.5 | 0.679 | 0.612–0.745 | <0.001 |
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Share and Cite
Subramaniam, S.; Chan, C.-Y.; Soelaiman, I.-N.; Mohamed, N.; Muhammad, N.; Ahmad, F.; Ng, P.-Y.; Jamil, N.A.; Abd Aziz, N.; Chin, K.-Y. Development of Osteoporosis Screening Algorithm for Population Aged 50 Years and above in Klang Valley, Malaysia. Int. J. Environ. Res. Public Health 2020, 17, 2526. https://doi.org/10.3390/ijerph17072526
Subramaniam S, Chan C-Y, Soelaiman I-N, Mohamed N, Muhammad N, Ahmad F, Ng P-Y, Jamil NA, Abd Aziz N, Chin K-Y. Development of Osteoporosis Screening Algorithm for Population Aged 50 Years and above in Klang Valley, Malaysia. International Journal of Environmental Research and Public Health. 2020; 17(7):2526. https://doi.org/10.3390/ijerph17072526
Chicago/Turabian StyleSubramaniam, Shaanthana, Chin-Yi Chan, Ima-Nirwana Soelaiman, Norazlina Mohamed, Norliza Muhammad, Fairus Ahmad, Pei-Yuen Ng, Nor Aini Jamil, Noorazah Abd Aziz, and Kok-Yong Chin. 2020. "Development of Osteoporosis Screening Algorithm for Population Aged 50 Years and above in Klang Valley, Malaysia" International Journal of Environmental Research and Public Health 17, no. 7: 2526. https://doi.org/10.3390/ijerph17072526