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J Clin Endocrinol Metab. 2014 Dec;99(12):4514-22. doi: 10.1210/jc.2014-2332.

Comparison of fracture risk prediction by the US Preventive Services Task Force strategy and two alternative strategies in women 50-64 years old in the Women's Health Initiative.

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  • 1Department of Internal Medicine (C.J.C.), University of California, Los Angeles, California 90095; Fred Hutchinson Cancer Research Center (J.C.L., A.L.), Seattle, Washington 98109; Mercy Health Osteoporosis and Bone Health Services (N.B.W.), Cincinnati, Ohio, 45236; Department of Family Medicine (M.L.G.), University of North Carolina, Chapel Hill, North Carolina 27514; Centre for Clinical Epidemiology and Evaluation (M.G.D.), University of British Columbia, Vancouver V5Z 1M9, Canada; Department of Epidemiology (J.A.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15213; Department of Social and Preventive Medicine (J.W.-W.), University at Buffalo, the State University of New York, Buffalo, New York, 14214; Department of Obstetrics and Gynecology (M.L.G.), Cleveland Clinic Center for Specialized Women's Health, Mayfield Heights, Ohio 44124; Center for Healthcare Policy and Research (J.A.R.), University of California Davis Medical Center, Sacramento, California 95817; and Division of Epidemiology and Community Health (K.E.E.), University of Minnesota Medical School, Minneapolis and Minneapolis VA Health Care System, Minneapolis, Minnesota 55454.



The United States Preventive Services Task Force (USPSTF) recommends osteoporosis screening for women younger than 65 years whose 10-year predicted risk of major osteoporotic fracture (MOF) is at least 9.3% using the Fracture Risk Assessment Tool. In postmenopausal women age 50-64 years old, it is uncertain how the USPSTF screening strategy compares with the Osteoporosis Self-Assessment Tool and the Simple Calculated Osteoporosis Risk Estimate (SCORE) in discriminating women who will and will not experience MOF.


This study aimed to assess the sensitivity, specificity, and area under the receiver operating characteristic curve of the three strategies for discrimination of incident MOF over 10 years of follow-up among postmenopausal women age 50-64 years.


This was a prospective study conducted between 1993-2008 at 40 US Centers.


We analyzed data from participants of the Women's Health Initiative Observational Study and Clinical Trials, age 50-64 years, not taking osteoporosis medication (n = 62 492).


The main outcome was 10-year (observed) incidence of MOF.


For identifying women with incident MOF, sensitivity of the strategies ranged from 25.8-39.8%, specificity ranged from 60.7-65.8%, and AUC values ranged from 0.52-0.56. The sensitivity of the USPSTF strategy for identifying incident MOF ranged from 4.7% (3.3-6.0) among women age 50-54 years to 37.3% (35.4-39.1) for women age 60-64 years. Adjusting the thresholds to improve sensitivity resulted in decreased specificity.


Our findings do not support use of the USPSTF strategy, Osteoporosis Self-Assessment Tool, or SCORE to identify younger postmenopausal women who are at higher risk of fracture. Our findings suggest that fracture prediction in younger postmenopausal women requires assessment of risk factors not included in currently available strategies.

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