Osteoporosis Risk Score - OST, SCORE and MORES Tally

The osteoporosis risk score is a structured pretest tally that uses age, weight, sex, and a few clinical factors to decide whether a DEXA bone density scan is warranted. The calculator combines three published tools - the Osteoporosis Self-Assessment Tool (OST), the Simple Calculated Osteoporosis Risk Estimation (SCORE) for women, and the Male Osteoporosis Risk Estimation Score (MORES) for men - and returns a sex-specific band for a DEXA referral discussion.

• • Routine primary care review: A clinician who wants a quick, validated pretest probability to decide whether to order a DEXA scan.
• • Postmenopausal bone health check: A woman over 50 who wants to see if her age, weight, fracture history, and other SCORE factors place her in the low, moderate, or high band.
• • Older man with COPD or low weight: A man over 50 with a low body weight or a chronic obstructive pulmonary disease diagnosis who wants a NHANES III-validated screening score.

Because the OST, SCORE, and MORES all use body weight as a core input, the BMI Calculator is a useful companion when you want to see how a high or low BMI lines up with the bone density risk band.

The calculator collects biological sex, age, weight, and the sex-specific sub-score inputs, then runs OST, SCORE (women), and MORES (men) side by side. The OST is always reported because it works for both sexes. The weight field is in pounds; the calculator converts to kilograms internally for the OST.

• OST: Weight in kilograms minus age in years, multiplied by 0.2 (Koh 2001, Skedros 2007). Sex-specific cut-points split the result into low, moderate, and high risk bands.
• SCORE (women): Sums ethnicity, fracture, rheumatoid arthritis, and estrogen sub-scores, then adds three times age over ten and subtracts weight in pounds over ten.
• MORES (men): Sums age band, weight band, and chronic obstructive pulmonary disease points. A total of six or more flags a man for DEXA.

According to Cass et al. 2016 MORES validation, the MORES used a NHANES III cohort of 1,498 men aged 50 and older and reported a sensitivity of 0.96, a specificity of 0.61, and an AUC of 0.87 for osteoporosis at the femoral neck or total hip.

When you run the SCORE branch, the BMI Women Calculator puts the same age and weight into a sex-specific BMI reading so you can see whether a borderline SCORE is being driven by a low body mass index.

The three tools share a common logic: they all combine a small set of validated risk factors to flag people who should be sent for a DEXA scan.

Since the MORES validation in NHANES III used body weight as the body-composition proxy, the Body Fat Percentage Calculator helps you see whether a low weight-driven MORES is from low lean mass or low body fat, which matters for the bone density picture.

Treat the inputs as a brief clinical review. Most users can fill them in under a minute, and the calculator updates as fields change.

1. 1 Pick the biological sex: Female runs OST and SCORE. Male runs OST and MORES. The sex choice switches which sex-specific OST cut-points apply.
2. 2 Enter age and weight in pounds: Use whole years at last birthday and current weight in pounds. The calculator converts to kilograms internally for the OST (1 kg = 2.2046 lbs); the SCORE keeps the pounds scale to match Lydick 1998.
3. 3 Fill the SCORE sub-scores (women only): Pick the highest-matching ethnicity, fracture history, rheumatoid arthritis, and estrogen use option. Fracture history is the one that most often changes the band.
4. 4 Fill the MORES sub-scores (men only): Pick the age band, weight band, and chronic obstructive pulmonary disease option. The COPD sub-score often lifts a borderline MORES into the high band.
5. 5 Read the result: If the OST and the sex-specific tool agree, the band is clear. If they disagree, the calculator uses the higher band as the overall recommendation.
6. 6 Take it to a clinician: A high band is a prompt to ask about a DEXA scan, not a diagnosis. A moderate band is a prompt to discuss modifiable risk factors and a baseline DEXA.

A practical use: a 67-year-old woman weighing 135 lbs (61.2 kg) who broke her wrist in a fall from standing. Her OST is 0.2 × (61.2 - 67) = -1.2, in the high risk band for women. Her SCORE is 5 + 4 + 0 + 1 + (3 x 67 / 10) - (135 / 10) = 16.6, also in the high band. Overall: High, with a DEXA referral prompt.

OST, SCORE, and MORES all use body weight as the dominant predictor, but lean mass tracks bone density more tightly than total weight, so the Lean Body Mass Calculator is a useful companion when a borderline risk band looks like it is being driven by a low lean mass reading.

OST, SCORE, and MORES can be done in the chart with a pen, but a calculator makes the tally consistent and easy to revisit.

• • Three tools, one page: Run OST for both sexes, SCORE for women, and MORES for men in a single pass.
• • Validated cut-points built in: The Koh 2001 and Skedros 2007 OST cut-points, the Lydick 1998 SCORE bands, and the Cass 2016 MORES threshold are built in.
• • Tells you when to ask about a DEXA scan: The overall band and recommendation field make it clear when the result is strong enough to bring up a DEXA scan at the next visit.

Several things can move the score up or down, and a few limitations are worth keeping in mind before acting on the result.

• • OST, SCORE, and MORES are screening tools, not diagnostic tests. A low band rules out very low bone density with reasonable confidence, but a high band still needs a DEXA scan and a clinical exam before a treatment plan changes.
• • FRAX, the WHO fracture risk assessment tool, answers a different question - the 10-year probability of a major osteoporotic fracture - and is what guidelines use to start treatment. Use OST, SCORE, and MORES to decide who should get a DEXA scan, not who should be started on a bisphosphonate.

According to Lydick 1998 SCORE development, the SCORE was developed in a managed-care population of postmenopausal women with low bone density, with a low risk band below 7 points, a moderate band from 7 to 15, and a high band above 15.

According to Skedros 2007 OST validation, the US orthopaedic cohort confirmed the OST formula and the sex-specific cut-points, with a sensitivity of 85% and a specificity of 64% at the OST <2 cutoff in men.

Because OST, SCORE, and MORES are used in the geriatric age range, the Geriatric BMI Calculator is a natural companion for reviewing whether an underweight finding is driving a high risk band in an older patient.