Predictive Accuracy of the Osteoporosis Self-Assessment Tool (OSTA) for Hip Fracture in Premenopausal women’s

Abstract

Perimenopausal women with type 2 diabetes mellitus (T2DM) face an elevated risk of osteoporotic hip fractures. The Osteoporosis Self-Assessment Tool for Asians (OSTA), which relies on age and body weight, is a simple screening method. However, its effectiveness in predicting fracture risk in this specific population remains unclear, particularly due to the complex relationship between T2DM and bone mineral density (BMD), as well as limited access to DXA scans. AIM - To assess the predictive ability of OSTA for hip fracture risk in perimenopausal women with T2DM. Methods: This retrospective study was conducted at Shri Mata Vaishno Devi Narayana Super Speciality Hospital between 2024 and 2025. The study included 182 women going through perimenopause. Of these, 62 had low-energy hip fractures, and 120 were controls, matched for age (within ±2 years), who had not had fractures. People with conditions affecting bone metabolism or significant spinal deformities were not included. OSTA scores were calculated using the standard formula [(weight in kg − age in years) × 0.2] and were classified as high risk (< −4), intermediate risk (−4 to −1), or low risk (> −1). Bone mineral density (BMD) was measured for all participants. The statistical methods included independent t-tests, analysis of covariance (ANCOVA), and receiver operating Characteristic (ROC) curve analysis. A p-value of less than 0.05 was used to determine statistical significance.
Results: Women in the fracture group were younger (67 ± 9.09 vs. 70.5 ± 8.02 years, p = 0.0123), taller (172 ± 8.09 vs. 168 ± 5.99 cm, p = 0.0009), and heavier (73 ± 9.75 vs. 44.15 ± 9.8 kg, p < 0.001) compared to the control group. Mean OSTA scores were higher in the fracture group (0.9 ± 2.75 vs. 0.29 ± 2.7), but the difference was not statistically significant (p = 0.1591). ROC curve analysis demonstrated poor predictive performance of OSTA for hip fracture risk (AUC = 0.534). The prevalence of osteoporosis was higher in the fracture group (66.7%) than in controls (41.4%).
Conclusion: The OSTA tool’s predictive capacity for hip fracture risk in perimenopausal women with T2DM appears constrained, potentially due to the elevated body weight characteristic of this demographic. Although its straightforward design renders it appropriate for environments with limited resources, additional refinement is essential to enhance its precision within this particular cohort

Results: Women in the fracture group were younger (67 ± 9.09 vs. 70.5 ± 8.02 years, p = 0.0123), taller (172 ± 8.09 vs. 168 ± 5.99 cm, p = 0.0009), and heavier (73 ± 9.75 vs. 44.15 ± 9.8 kg, p < 0.001) compared to the control group. Mean OSTA scores were higher in the fracture group (0.9 ± 2.75 vs. 0.29 ± 2.7), but the difference was not statistically significant (p = 0.1591). ROC curve analysis demonstrated poor predictive performance of OSTA for hip fracture risk (AUC = 0.534). The prevalence of osteoporosis was higher in the fracture group (66.7%) than in controls (41.4%).

Conclusion: The OSTA tool's predictive capacity for hip fracture risk in perimenopausal women with T2DM appears constrained, potentially due to the elevated body weight characteristic of this demographic. Although its straightforward design renders it appropriate for environments with limited resources, additional refinement is essential to enhance its precision within this particular cohort.