Shepherd AJ et al. (2007) Development and internal validation of the male osteoporosis risk estimation score. Ann Fam Med 5: 540–546

The risk of hip fracture for women with osteoporosis can be reduced by early identification and treatment. Guidelines for primary screening of men, however, are lacking and, although hip fracture is less common in men, it is associated with higher mortality. Shepherd et al., therefore, developed and validated a clinical prediction rule to identify US men at increased risk of osteoporosis and hip fracture.

Data of 2,995 men (aged ≥50 years) from the National Health and Nutrition Examination Survey III who had valid dual-energy X-ray absorptiometry (DXA) data were randomly allocated to a development (n = 1,497) or validation (n = 1,498) cohort. A best-fitting multivariable logistic regression analysis identified three important predictive variables for osteoporosis—age, weight and history of chronic obstructive pulmonary disease, with low weight (≤70 kg) having the strongest predictive validity. These three variables were included in a simple scoring algorithm to determine which men should be referred for DXA. A Male Osteoporosis Risk Estimation Score (MORES) of ≥6 correctly identified 93% of the men with osteoporosis in the overall cohort and had high predictive ability in the validation cohort. Furthermore, a simulated number-needed-to-screen analysis was favorable, especially for older age-groups (≥60 years).

The authors conclude that the MORES performs well compared with other available risk assessment guidelines for men, and is a valid approach for men aged ≥60 years that has the potential to reduce osteoporotic fractures and associated mortality.