Determining risk of vertebral osteoporosis in men: Validation of the male osteoporosis risk estimation score

Background: Vertebral fracture, one of the most frequent osteoporotic fractures in both sexes, is a powerful indicator of future osteoporotic fractures. Vertebral fractures are associated with increased mortality and decreased quality of life. Osteoporosis is a major predictor of low-trauma fracture. The Male Osteoporosis Risk Estimation Score (MORES), a clinical prediction tool that uses age, weight, and a history of chronic obstructive pulmonary disorder, was developed and validated previously to identify men at risk for hip osteoporosis who might benefit from bone densitometry. This study evaluated the effectiveness of the MORES to identify men at risk of lumbar osteoporosis. Methods: US population data from the National Health and Nutrition Examination Survey (NHANES, 1999-2004) were used to test the validity of the MORES to identify men at risk of lumbar osteoporosis. Results: The MORES value was compared with vertebral done densitometry (DXA) scores for men 50 years of age and older. The sensitivity was 0.582 (95% CI, 0.460-0.694) and specificity was 0.652 (95% CI, 0.627- 0.676). Comparing universal DXA screening in 50-year-old men, the number needed to screen (NNS) to prevent one case of vertebral fracture would be reduced from 9418 to 3641 by prescreening with the MORES. In 70-year-old men, the MORES reduced the NNS from 4987 with universal screening to 3583. Conclusion: This analysis validated the MORES as a clinical tool to identify men at risk for lumbar osteoporosis. Compared with universal screening, the MORES was able to reduce the NNS to prevent one additional vertebral fracture across all age groups except in men 85 to 89 years of age. The magnitude of the NNS to prevent one additional vertebral fracture does not support using the MORES to screen solely for osteoporosis of the lumbar spine.