ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2026
Revisiting the Osteoporosis Self-Assessment Tool (OST): evidence from a multi-cohort study in Asia supporting age-dependent thresholds.
Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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3 citing papers in PubMed.
- In response to Bobelyak et al. (2025), Pocock and Chan (2025) and Chan et al. (2026).Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- A rebuttal letter: Author response to: OSIN-D-26-00862: Letter to the Editors: REMS is not just an age and weight calculator.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Author response to Letter to the Editor by Yang et al. regarding Radiofrequency echographic multispectrometry in total hip arthroplasty: validation and clinical translation.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
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Abstract
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.
methodsWomen (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.
resultsOST 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.
conclusionOST thresholds show substantial variation in performance across age groups. Age-dependent thresholds provide a more appropriate framework for osteoporosis screening.
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