Historical assessment of risk factors in screening for osteopenia in a normal Caucasian population

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Abstract
Background: Bone mineral density (BMD) can predict fracture, however, the common use of historical risk factors to predict low BMD is unproven. Aims: To identify significant historical risk factors for osteopenia. To establish predicting equations for BMD and test their ability to identify those who should be referred for BMD scanning. Methods: Three hundred and twenty female and 131 male volunteers underwent questionnaire assessment of risk factors and BMD by dual photon absorptiometer at hip and spine. Significant risk factors (P < 0.05) were used to construct a linear regression model to predict BMD. This was cross validated on a second sample of 107 females and 131 males selected from the electoral roll analysing the ability to detect those subjects with BMD in the lower third of the age matched normal range. Results: In women lower BMD at the spine was associated with increased age, decreased weight, smoking, and delayed menarche. Lower femoral BMD was associated with increased age, decreased weight, family history, inactivity, and smoking. In men lower BMD at the lumbar spine was associated with lower weight, and inactivity. Lower BMD at the femur was associated with increased age, decreased weight, family history, and low calcium intake. When cross validated on the second sample, the models produced sensitivity of 86–89% and sensitivity of 25–46%. Referring those with these risk factors could save 10–23% on scanning. Measuring BMD at the site in question remains the only accurate way of assessing an individual's risk of osteopenia. (Aust NZ J Med 1993; 23: 458–462.)