OSTA Evaluated for DXA Prioritization Across US, Korean, and Chinese Cohorts

In an evaluation of the Osteoporosis Self-assessment Tool for Asians (OSTA) for dual-energy X-ray absorptiometry (DXA) prioritization, researchers observed external areas under the curve ranging from 0.754 to 0.831. Applying a United States threshold targeting a 20 percent referral workload selected 50.9 percent and 53.4 percent of participants in Korean surveys, or 48.7 percent and 49.4 percent following age standardization.

While pooled target percentiles fixed referral at 20 percent, sensitivity among women aged 50 to 59 years was 4.6 percent across both Korean survey periods. In addition, age-specific allocation reduced overall sensitivity from 52.1 percent to 34.6 percent and from 50.9 percent to 39.3 percent, indicating that controlling referral workload did not preserve age-specific detection.

The research evaluated women aged 50 to 79 years across US and Korean DXA surveys alongside the China Health and Retirement Longitudinal Study (CHARLS). Survey-weighted analyses assessed femoral-neck osteoporosis using a common US T-score reference, while 1,000 cluster bootstrap replicates quantified discrimination and referral uncertainty, including paired allocation contrasts. In community-cluster Cox and competing-risk models assessing self-reported hip fracture in CHARLS, 223 fractures were recorded over a median follow-up of 9 years, with the highest-risk 20 percent capturing 29.1 percent of events (adjusted hazard ratio 1.70, 95 percent confidence interval 1.26 to 2.29).

The authors reported that CHARLS had no DXA data and femoral-neck osteoporosis was not verified in Chinese women, noting that the CHARLS associations do not establish prognostic information independent of age and weight. Because controlling workload failed to preserve age-specific detection, the authors concluded that percentile allocation requires prospective evaluation rather than stand-alone clinical adoption amid increasing assessment demand driven by population ageing.

Subject of Research: Osteoporosis screening and dual-energy X-ray absorptiometry prioritization

Article Title: OSTA for DXA prioritization: US-Korean imaging validation and hip-fracture follow-up in China

Article References: Li, Z., Niu, S., Liu, Y., & Zhou, Z. (2026). OSTA for DXA prioritization: US-Korean imaging validation and hip-fracture follow-up in China. Aging Clinical and Experimental Research. https://doi.org/10.1007/s40520-026-03564-4

Image Credits: AI Generated

DOI: 10.1007/s40520-026-03564-4

Keywords: osteoporosis, dual-energy X-ray absorptiometry, OSTA, femoral-neck osteoporosis, hip fracture, CHARLS, screening prioritization, prioritization, US-Korean, imaging, validation, hip-fracture