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postmenopausal women with one or more risk factors should have BMD measurements[9]. But it is not possible for all women satisfied with the conditions mentioned above to receive DXA measurements in China, because of little physicians' and patients' awareness, little public heath policy support, and so on. Therefore, we want to find out patients in high risk of osteoporosis using simple tools such as OSTA, which had been validated well in classifying the osteoporotic risk among postmenopausal women. There are many risk assessment indices in identifying women at moderate or high risk of osteoporosis who need Journal of Orthopaedic Surgery and Research 2006, 1:14 http://www.josr-online.com/content/1/1/14 Page 3 of 6 (page number not for citation purposes) BMD measurements by DXA, such as Osteoporosis Index of Risk (OSIRIS), Simple Calculated Osteoporosis Risk Estimation (SCORE), Osteoporosis Risk Assessment Instrument (ORAI), and OSTA. All of these tools were predicting osteoporosis risk according to age, weight, race, history of fracture, history of medication, and so on. The main results were displayed in table 3. It was said the OSTA, based only on age and weight, could perform well in assessing risk categories[4,5,8,10-14]. In our study involving 218 Asian postmenopausal women of Han nationality in Sichuan Province with a mean age of 59.0 years, the OSTA index did not perform very well in identifying women of high risk whose LS BMD by DXA measurements were very low (T score less than -2.5 or -2.0). For example, among the 88 (40.4%) women of osteoporosis using a T score cutoff -2.5 by DXA, only 52 women were identified moderate or high risk by OSTA risk index. It means 41% women of osteoporosis will be neglected if they were assessed only by OSTA index. Meanwhile, among the 130 women of non-OP (osteopenia or normal bone mass), only 74 (57%) women were low risk by OSTA who did not need BMD measurement. We found the performance of OSTA risk index is not as satisfied as those reported in Asian or other races and it can not help us precisely to give judgement on whether a Prevalence of osteoporosis by age and T score cutoffs (T Figure 1 ≤ -2.5 and T ≤ -2.0) of DXA measurement Prevalence of osteoporosis by age and T score cutoffs (T ≤ -2.5 and T ≤ -2.0) of DXA measurement. Journal of Orthopaedic Surgery and Research 2006, 1:14 http://www.josr-online.com/content/1/1/14 Page 4 of 6 (page number not for citation purposes) Prevalence of osteoporosis Figure 3 according to various T score cutoffs at different levels of OSTA risk index Prevalence of osteoporosis according to various T score cutoffs at different levels of OSTA risk index. (Categorization used in Asian women by koh et al[4]. Numbers of women in low, moderate, and high risk group are 110, 92, 16, respectively.) Distribution of the patients acco Figure 2 rding to their OSTA risk index Distribution of the patients according to their OSTA risk index. Journal of Orthopaedic Surgery and Research 2006, 1:14 http://www.josr-online.com/content/1/1/14 Page 5 of 6 (page number not for citation purposes) DXA measurement of LS BMD should be given to a postmenopausal women or not. Because our subjects were from hospital, not from an epidemiologic investigation, the prevalence of osteoporosis was rather higher than those reported in Asian women[4]. Through a woman's life, there are so many risk factors for osteoporosis, such as age, race, hormone conditions, heredity, weight, nutritional status, history of fracture, childbearing, and so on[15]. We think there were limitations in OSTA risk index by using only age and weight. According to the OSTA formula, if the weight (in kilograms) of a woman surpasses her age (in years), she will always be in low risk of osteoporosis. It is of some absurd for you to tell your patient that when she was 90 years old, she should keep the body weight 90 kg for prevention of osteoporosis. The ROC curve for OSTA inde off -2.0 by DXA measurement Figure 5 x using LS BMD T score cutThe ROC curve for OSTA index using LS BMD T score cutoff -2.0 by DXA measurement. Table 1: Fourfold table of OSTA comparing with LS BMD by DXA LS BMD by DXA T ≤ -2.5 T ≤ -2.0 OSTA index OP non-OP total OP non-OP total moderate-high risk 52 56 108 77 31 108 low risk 36 74 110 57 53 110 total 88 130 218 134 84 218 Table 2: Performance of OSTA index by LS BMD and various T score cutoffs Sen. Spe. Accuracy T ≤ -2.5 59.1% 56.9% 57.8% T ≤ -2.0 57.5% 63.1% 59.6% The ROC curve for OSTA inde off -2.5 by DXA measurement Figure 4 x using LS BMD T score cutThe ROC curve for OSTA index using LS BMD T score cutoff -2.5 by DXA measurement. 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