Validation of the male osteoporosis risk estimation score (MORES) in a primary care setting

Background: primary care physicians are positioned to promote early recognition and treatment of men at risk for osteoporosis-related fractures; however,efficient screening strategies are needed. this study was designed to validate the male osteoporosis risk estimation score (mores) for identifying men at increased risk of osteoporosis. methods: this was a blinded analysis of the mores,administered prospectively in a cross-sectional sample of men aged 60 years or older. participants completed a research questionnaire at an outpatient visit and had a dual-energy x-ray absorptiometry (dxa) scan to assess bone density. sensitivity,specificity,and area under-the-curve (auc) were estimated for the mores. effectiveness was assessed by the number needed-to-screen (nns) to prevent one additional major osteoporotic fracture. results: a total of 346 men completed the study. the mean age was 70.2 ± 6.9 years; 76% were non- hispanic white. fifteen men (4.3%) had osteoporosis of the hip. the operating characteristics were sensitivity 0.80 (95% confidence interval [ci],0.52- 0.96); specificity 0.70 (95% ci,0.64-0.74),and auc of 0.82 (95% ci,0.71- 0.92). screening with the mores yielded a nns to prevent one additional major osteoporotic fracture over 10 years with 259 (95% ci,192-449) compared to 636 for universal screening with a dxa. conclusion: this study validated the mores as an effective and efficient approach to identifying men at increased risk of osteoporosis who may benefit from a diagnostic dxa scan. (j am board fam med 2013;26:436-444.).