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Summary <p>The Osteoporosis Self-Assessment Tool (OST) is a useful discriminator of densitometric osteoporosis, but its long-used fixed threshold performs poorly, especially in younger postmenopausal women. In this multi-ethnic cohort study, optimal screening thresholds varied strikingly by age, supporting a shift from a single cut-off to age-dependent thresholds.</p> Purpose <p>The Osteoporosis Self-Assessment Tool (OST) is used worldwide to identify individuals likely to have osteoporosis on dual-energy X-ray absorptiometry (DXA) and fixed thresholds are widely used. We evaluated OST performance in a multi-ethnic population and examined whether age-dependent thresholds better reflect its role as a screening tool.</p> Methods <p>Women (<i>n</i> = 2787) and men (<i>n</i> = 1465), ≥ 50 and ≥ 60-years respectively, from three cohorts were studied. Osteoporosis was defined as a DXA T-score ≤  − 2.5 at the lumbar spine, total hip, or femoral neck. We evaluated the originally identified (≤ − 1), the historically propagated- (≤ − 4), Youden index–derived-, and screening-oriented-OST thresholds targeting 80% sensitivity. Stability was assessed using fivefold cross-validation supported by a real-world patient cohort.</p> Results <p>OST showed acceptable discrimination (AUC 0.79 in women; 0.72 in men). The − 1 threshold showed only moderate sensitivity in younger women (0.54, aged 50–59&#xa0;years) and poor specificity in older women (0.21, aged 70–79&#xa0;years; 0.03 at ≥ 80&#xa0;years). The − 4 threshold showed poor sensitivity overall, particularly in younger women (0.02, aged 50–59&#xa0;years; 0.14, aged 60–69&#xa0;years). Youden thresholds demonstrated clear age-dependence shifting from − 0.15, (50–59&#xa0;years) to − 6.20 (≥ 80&#xa0;years), with stability on cross-validation ((mean − 2.18, SD 0.45))<i>.</i> Screening thresholds targeting 80% sensitivity also showed a steep age-dependent gradient (+ 0.25 to − 5.39). Similar age-dependent patterns were observed in men.</p> Conclusion <p>OST thresholds show substantial variation in performance across age groups. Age-dependent thresholds provide a more appropriate framework for osteoporosis screening.</p>

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Revisiting the Osteoporosis Self-Assessment Tool (OST): evidence from a multi-cohort study in Asia supporting age-dependent thresholds

  • 期刊论文

  • 发表日期：

    2026年6月26日

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  • Manju Chandran,
  • Chiew Meng Johnny Wong,
  • Benedikt Helgason,
  • Yong Eu Leong,
  • Angelique Chan,
  • Rahul Malhotra,
  • Preeti Gupta,
  • Dheeraj Jha,
  • Anitha D. Praveen,
  • Darren Yuen Zhang Tan,
  • Hui Min Charlotte Choo,
  • Ecosse L. Lamoureux

摘要

Summary

The Osteoporosis Self-Assessment Tool (OST) is a useful discriminator of densitometric osteoporosis, but its long-used fixed threshold performs poorly, especially in younger postmenopausal women. In this multi-ethnic cohort study, optimal screening thresholds varied strikingly by age, supporting a shift from a single cut-off to age-dependent thresholds.

Purpose

The Osteoporosis Self-Assessment Tool (OST) is used worldwide to identify individuals likely to have osteoporosis on dual-energy X-ray absorptiometry (DXA) and fixed thresholds are widely used. We evaluated OST performance in a multi-ethnic population and examined whether age-dependent thresholds better reflect its role as a screening tool.

Methods

Women (n = 2787) and men (n = 1465), ≥ 50 and ≥ 60-years respectively, from three cohorts were studied. Osteoporosis was defined as a DXA T-score ≤  − 2.5 at the lumbar spine, total hip, or femoral neck. We evaluated the originally identified (≤ − 1), the historically propagated- (≤ − 4), Youden index–derived-, and screening-oriented-OST thresholds targeting 80% sensitivity. Stability was assessed using fivefold cross-validation supported by a real-world patient cohort.

Results

OST showed acceptable discrimination (AUC 0.79 in women; 0.72 in men). The − 1 threshold showed only moderate sensitivity in younger women (0.54, aged 50–59 years) and poor specificity in older women (0.21, aged 70–79 years; 0.03 at ≥ 80 years). The − 4 threshold showed poor sensitivity overall, particularly in younger women (0.02, aged 50–59 years; 0.14, aged 60–69 years). Youden thresholds demonstrated clear age-dependence shifting from − 0.15, (50–59 years) to − 6.20 (≥ 80 years), with stability on cross-validation ((mean − 2.18, SD 0.45)). Screening thresholds targeting 80% sensitivity also showed a steep age-dependent gradient (+ 0.25 to − 5.39). Similar age-dependent patterns were observed in men.

Conclusion

OST thresholds show substantial variation in performance across age groups. Age-dependent thresholds provide a more appropriate framework for osteoporosis screening.