Retrospective Development and Internal Validation of a Diagnostic Model to Identify Secondary Osteoporosis in Community-Dwelling Older Men
Abstract
Objective: To develop and validate a clinical prediction model integrating lumbar spine bone mineral density (LS-BMD) and fall risk assessment for identifying secondary osteoporosis in community-dwelling elderly men.
Methods: This retrospective cross-sectional study enrolled men aged 65 years or older from community health centers and geriatric outpatient clinics (June 2023-December 2025). Secondary osteoporosis was defined as T-score ≤ -2.5 at any site (lumbar spine, femoral neck, or total hip) with at least one confirmed major secondary etiology (hypogonadism, glucocorticoid use, vitamin D deficiency, etc). Controls were men with normal BMD or osteopenia without secondary etiology. Participants were randomly assigned to training (70%) and validation (30%) sets. LASSO regression and multivariate logistic regression were used for variable selection and model construction. Bootstrap resampling provided optimism-corrected performance estimates.
Results: Among 843 eligible participants (mean age 73.12±5.27 years), 187 (22.18%) were diagnosed with secondary osteoporosis. Six independent predictors were identified: age, LS-BMD T-score, history of fall, testosterone, glucocorticoid use, and vitamin D level. The apparent AUC was 0.846 (95% CI: 0.815-0.878) in the training set and 0.798 (95% CI: 0.741-0.854) in the validation set; the optimism-corrected AUC was 0.731, indicating moderate discrimination. Calibration was satisfactory. Decision curve analysis confirmed clinical net…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 843 participants or records.
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