METHODS: This study was performed using the data of Bushehr Elderly Health (BEH) program, a population-based cohort study of elderly population aged ≥ 60 years. Seven osteoporosis risk assessment tools, including Osteoporosis Risk Assessment Instrument (ORAI), Malaysian Osteoporosis Screening Tool (MOST), Osteoporosis Prescreening Risk Assessment (OPERA), Osteoporosis Prescreening Model for Iranian Postmenopausal women (OPMIP), Osteoporosis Index of Risk (OSIRIS), and Osteoporosis Self-Assessment Tool for Asians (OSTA), as well as Fracture Risk Assessment Tool (FRAX) were included in the study. By using osteoporosis definition based on BMD results, the performance measurement criteria of diagnostic tests such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Youden index for each model were calculated and the models were compared.

RESULTS: A total of 1237 female participants with the mean age of 69.1 ± 6.3 years were included. Overall, 733 (59%) participants had osteoporosis, and about 80% had no history of fracture. The sensitivity of the seven models ranged from 16.7% (OSIRIS) to 100% (ORAI and MOST) at their recommended cut-off points. Moreover,their specificity ranged from 0.0% (ORAI and MOST) to 78.9% (OSTA). The FRAX and OPERA had the optimal performance with the Youden index of 0.237 and 0.226, respectively. Moreover, after combining these models, the sensitivity of them increased to 85.4%.