Sensitivity, specificity, positive and negative predictive values of the criteria for indicating a bone densitometry in the Evaluation of Medical Techniques and Research in Cataluña

Roig Vilaseca, Daniel; Valero García, Carles; Pilar Boncompte Vilanova, M.; Muñoz López, Juli; Contreras García, Carme; Romera Baurés, Montserrat

doi:10.1016/S2173-5743(11)70035-1

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Abstract

The Catalan Agency for Health Technology Assessment and Research (AETIM) proposed, in 2001, criteria for performing a bone densitometry (BD) for use in the consultations of the public health system.

Objective

To determine the sensitivity, specificity, positive predictive value and negative predictive value of the criteria to indicate BD.

Material and methods

Five groups of volunteers (premenopausal women aged 46 to 65 years, postmenopausal women aged 46 to 65 years, postmenopausal women aged >65 years and men 46 to 65 years and >65 years) underwent BD and a questionnaire on risk factors. The results obtained with the AETIM criteria are related to criteria for indication of BD proposed by the World Health Organization (1999 and 2003 criteria), the National Osteoporosis Foundation (1998 and 2010 criteria) and the International Committee of Clinical Guidelines on Osteoporosis.

Results

Criteria from the Catalan Agency have low sensitivity to detect both low bone mass (T index <−1) and osteoporosis (T index <−2.5), specificity varied according to the group. The positive predictive value is low, but the negative predictive value for osteoporosis is high in all groups (except for postmenopausal women aged >65 years). The remaining criteria have a high negative predictive value and, in women, good sensitivity and low specificity, especially for identifying patients with osteoporosis.

Conclusion

Catalan Agency criteria are useful for selecting patients who would not need BD, but lack sufficient sensitivity to identify individuals with low bone mass. The other criteria also have a high negative predictive value for osteoporosis, and a better sensitivity.

Keywords:

Bone densitometry

Sensibility

Specificity

Positive predictive value

Negative predictive value

Indication

Criteria

Resumen

Objetivo

La Agencia de Evaluación de Tecnologías e Investigación Médicas (AETIM) de Cataluña propuso en 2001 unos criterios de indicación de densitometría ósea (DO) para su uso en las consultas del sistema sanitario público. El objetivo fue conocer la sensibilidad, la especificidad, el valor predictivo positivo (VPP) y valor predictivo negativo (VPN) de los criterios de indicación de DO de la AETIM.

Material y método

Cinco grupos de voluntarios (mujeres premenopáusicas de 46 a 65 años, posmenopáusicas de 46 a 65 años y posmenopáusicas de > 65 años, y varones de 46 a 65 años y de > 65 años) a los que se realizó DO y una encuesta sobre factores de riesgo. Se calcularon la sensibilidad, la especificidad, el VPP y el VPN de los criterios de la AETIM, y los resultados se compararon con los criterios de indicación de DO propuestos por la Organización Mundial de la Salud (en 1999 y 2003), la National Osteoporosis Foundation (en 1998 y 2010) y el Comité Internacional de Guías Clínicas en Osteoporosis.

Resultados

Los criterios de la AETIM tienen una baja sensibilidad tanto para detectar baja masa ósea (índice T < −1) como osteoporosis (índice T < −2,5); la especificidad varía según el grupo. El VPP es bajo, pero el VPN para osteoporosis es alto en todos los grupos (excepto el de mujeres posmenopáusicas > 65 años). El resto de los criterios tienen un VPN alto y, en mujeres, buena sensibilidad y muy baja especificidad, especialmente para identificar pacientes con osteoporosis.

Conclusiones

Los criterios de la AETIM son útiles para seleccionar pacientes a los que no sería necesario realizar una DO, pero carecen de sensibilidad suficiente para identificar individuos con baja masa ósea. El resto de criterios tienen también un VPN alto para osteoporosis y una sensibilidad algo mejor.

Palabras clave:

Densitometría ósea

Sensibilidad

Especificidad

Valor predictivo positivo

Valor predictivo negativo

Indicación

Criterios

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