SCORE questionnaire used with permission of Merck & Co., Inc. Reproduction without written permission of Merck is expressly forbidden.

SCORE Background Information

Introduction
The majority of women with osteoporosis have no visible signs or symptoms. Score, or Simple Calculated Osteoporosis Risk Estimation, is a simple test that has been developed to help identify postmenopausal women age 50 and over who should be evaluated further for osteoporosis.

Study Design
A study was undertaken to develop a predictive model for identification of postmenopausal women likely to have low bone mass.

Community dwelling peri- and postmenopausal women age 45 or older without regard to race or ethnicity were eligible for this study. Women answered approximately 60 questions suspected of association with osteoporosis. Item selection for the questionnaire was based on an extensive review of the medical literature.

Bone mineral density (BMD) was determined at both the hip and PA lumbar spine using dual energy x-ray absorptiometry. For this study, low BMD was defined as 2.0 standard deviations or more below mean young normal bone mass for Caucasian women at the femoral neck.

A variety of statistical analysis were used to determine the correlation between BMD and a given factor or set of factors. Factors with marginal correlation (p<0.2) were retained as candidate factors.

Linear regression models estimated the BMD T-score for a woman with a given set of candidate factors. The resulting prediction was then used to estimate the probability the woman would have low BMD. If this probability exceeded a prespecified probability, the woman would be classified as having low BMD and referred for further evaluation by bone densitometry.

An expression that preserved the predictive ability but had a simplified form was developed using those factors selected by the linear regression model as input. The specific values for variables were modified by rounding the linear regression coefficients to integer values. The integer values thus derived for each variable are then summed to give SCORE or Simple Calculation of Osteoporosis Risk Estimation.

In this study, SCORE identified women with low BMD at the hip with approximately 90% sensitivity and at least 40% specificity in both the development and validation cohorts.





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