53 

Appendix A. Data Collection Forms 
54 

VA-EPC Male/OP Project Screener 

Reviewers: 

Article ID Assigned on: 

Citation: 

Reviewer: ___________________________ 

First Author:_________________________ 

1. Does the article report original data on the 

prevalence or incidence of any of the following in 

men? 

 (Check all that apply) 

Osteopenia .................................................... 

Osteoporosis.................................................. 

Fractures ....................................................... 

None of the above ......................................... 

2. Does the article report original data on risk factors 

for osteopenia, osteoporosis, or fractures in men? 

 (Circle one) 

Yes................................................................1 

No.................................................................2 

3. Does the article report on a tool to screen for 

osteoporosis in men? 

 [tool=radiologic studies, surveys, etc] 

 (Circle one) 

Yes................................................................ 1 

No.................................................................2 

4. Does the article report associations between BMD 

levels as determined by DXA and fractures in men? 

 (Circle one) 

Yes................................................................ 1 

No.................................................................2 

5. Study design 

 (Circle one) 

RCT/CCT..................................................... 1 

Cohort/case series ........................................2 

Case control .................................................3 

Review article: systematic or M-A ............. 4 

Review article: not systematic ................... 5 (STOP) 

Review article: letter, editorial, 

other syst review......................................... 6 (STOP) 

Other........................................................... 7 (STOP) 

6. Are any of the subjects identified as veterans? 

 (Circle one) 

Yes.......................................................... 1 

No............................................................ 2 

7. Should this article be saved for background? 

(Circle one) 

Yes.......................................................... 1 

No............................................................ 2 

NOTES: 
VA Male OP Project-Detailed Review Form- Diagnostic Studies

49 

Do you think that this article might include the same data as another study? (CIRCLE ONE)Yes 1 No 2 

 If YES enter Trial name and/or IDs: 

Trial name : ___________________________ ID(s) : ________________________________ 

What is the study test? 

(CHECK ALL THAT APPLY)

Ultrasound, BUA ....................................................



Ultrasound, SOS .....................................................



Ultrasound, QUI......................................................



Peripheral bone density, pDXA ..............................



Peripheral bone density, SXA.................................



Peripheral bone density, other: _______________.



Central DXA ..........................................................  Quantitative CT ......................................................  Bone markers .........................................................  

 Questionnaire, OST.................................................

  

Questionnaire, other: ____________________......



Other: ________________________________ .....  Other: ________________________________ .....



If applicable, at what anatomic site was 

Spine........................................

Femur ......................................

Radius......................................

Patella......................................

Calcaneus ................................

Finger ......................................

Other: ___________________Not applicable .........................

Not reported ............................

What is the reference test? 

Ultrasound, BUA.....................

Ultrasound, SOS......................

Ultrasound, QUI......................

Peripheral bone density, pDXA 

Peripheral bone density, SXA .

Peripheral bone density, other: 

Central DXA ..........................Quantitative CT ......................

 Questionnaire, OST..................

Questionnaire, other: ________Prior fractures..........................

Prior self-reported osteoporosi

Other: ___________________Other: ___________________

F

Article ID: Reviewer:______________ 

First Author: ____________________________________ 

 (Last Name Only) Study Number: ___of____Description:________________ 

(Enter ‘1of 1’ if only one) (if more than one study)
VA Male OP Project-Detailed Review Form- Diagnostic Studies

50 

If applicable, at what anatomic site was the reference test performed? 

(CHECK ALL THAT APPLY)

Spine .......................................................................



Femur......................................................................



Radius .....................................................................



Patella......................................................................



Calcaneus ................................................................



Finger......................................................................  Other: _____________________________ ..........  

Not applicable .........................................................



Not reported ............................................................



Who is studied? (CHECK ALL THAT APPLY)A. Not reported 



B. Unselected population 



C. Selected population 



Elderly  

Nursing home  

Referred  Prior glucocorticoid use  COPD  Hypogonadal  

Excess alcohol  

Malabsorption  Other: __________________________ 



What was the male sample size data? (Enter number or 9999 for not reported)

Enrolled: _________ Followed up: _________ 

What were the characteristics of the pa

Caucasian..................

African Ancestry.......

Hispanic....................

Asian (non-Filipino) .

Filipino .....................

Native American.......Eskimo/Inuit .............

Other (_________ _______

Veteran .....................Characteristics not rep

In what region did the study take place

US/Canada................Scandinavia...............

Australia/NZ .............

Western Europe ........

Eastern Europe..........

Latin America...........

Middle East...............

India..........................

Africa........................

Asia...........................

Other : ____________

Not reported..............

Does the article report sensitivity, s

construct 2 X 2 table? 

Sensitivity.................Specificity.................

Correlation................

Other : ____________Not reported..............
VA Male OP QUADAS Quality Review Form

51 

1. Was the spectrum of patients representative of the patients who 

will receive the test in practice? 

(CIRCLE ONE)

Yes 1 No 2 Unclear 3 *How to score: Score ‘yes’ if based on information reported from study’s authors, you believe the spectrum of patients included in the study is representative of those in whom the test will be used in practice. Judgment should be based on both method of recruitment and the characteristics of those recruited. Score ‘no’ if you think the population studied does not fit into what was specified as acceptable. Score ‘no’ if studies recruit a group of healthy controls and a group known to have the target disorder. 2. Were selection criteria clearly described? 

(CIRCLE ONE)

Yes 1 No 2 Unclear 3 *How to score: Score ‘yes’ if you think all relevant information regarding how participants were selected for inclusion has been provided. Score ‘no’ if study selection criteria are not clearly reported. 3. Is the reference standard likely to correctly classify the target 

condition? 

(CIRCLE ONE)

Yes 1 No 2 Unclear 3 *How to score: Score ‘yes’ if you believe the reference standard is likely to correctly classify the target condition or is the best method available. Score ‘no’ if you do not think the reference standard was likely to have correctly classified the target condition. 

4. Is the time period between reference standa

reasonably sure that the target condition dtests? 

(C

Yes 1 No 2 Unclear 3 *How to score: For conditions that progress rapidly, sh

performance of index and ref test if very short. If condiappropriate. You will have to determine what is ‘short eperformance of index test and reference standard was schanged between the performance of the two tests. 

5. Did the whole sample or a random selectio

using a reference standard? 

(C

Yes 1 No 2 Unclear 3 *How to score: Score ‘yes’ if it is clear that all patients received index test went on to receive verification of di

‘no’ if some patients did not receive verification of disereference standard was not random. 

6. Did patients receive the same reference sta

result? 

(C

Yes 1 No 2 Unclear 3 *How to score: Score ‘yes’ if it is clear that patients recusing the same reference standard. Score ‘no’ if some pdifferent reference standard. 

Article ID: Reviewer:______________ 

First Author: ____________________________________ 

 (Last Name Only) Study Number: ___of____Description:________________ 

(Enter ‘1of 1’ if only one) (if more than one study)
VA Male OP QUADAS Quality Review Form

52 

7. Was the reference standard independent of the index test (i.e. the 

index test did not form part of the reference standard)? 

(CIRCLE ONE)

Yes 1 No 2 Unclear 3 *How to score: Score ‘yes’ if it is clear from the study that the index test did not form part of the reference standard. Score ‘no’ if it appears that the index test formed part of the reference standard. 8. Was the execution of the index test described in sufficient detail to 

permit replication of the test? 

(CIRCLE ONE)

Yes 1 No 2 Unclear 3 *How to score: SEE # 9 9. Was the execution of the reference standard described in sufficient 

detail to permit its replication? 

(CIRCLE ONE)

Yes 1 No 2 Unclear 3 *How to score: Score ‘yes’ if study reports sufficient details or citations to permit replication of the index test and reference standard. Score as ‘no’ in other cases. 10. Were the index test results interpreted without knowledge of the 

results of the reference standard? 

(CIRCLE ONE)

Yes 1 No 2 Unclear 3 *How to score: SEE # 11 

11. Were the reference standard results interp

results of the index test? 

(C

Yes 1 No 2 Unclear 3 *How to score: Score ‘yes’ if study clearly states that th

were interpreted blind to the results of the other test. Scwere interpreted blind to results of the other test. 

12. Were the same clinical data available whe

would be available when the test is used i

(C

Yes 1 No 2 Unclear 3 *How to score: Score ‘yes’ if clinical data would normin practice and similar data were available when interpr in the study and when clinical data would not be availaavailable when the index test results were interpreted. S13. Were uninterruptible/intermediate test res

(C

Yes 1 No 2 Unclear 3 *How to score: Score ‘yes’ if it is clear that all test resuuninterruptible/indeterminate/intermediate results are reresults occurred but have not been reported. 14. Were withdrawals from the study explain

(C

Yes 1 No 2 Unclear 3 *How to score: Score ‘yes’ if it is clear what happened example if a flow diagram of study participants is reporparticipants who entered the study did not completed thstudy (i.e. did not receive both the index test and refere

accounted for).
VA Male OP Project- RISK FACTOR STUDIES

53 

Are data in this article reported for MEN for the risk factors listed below? 

MODERATE RISK FACTORS 

(CHECK ALL THAT APPLY)

Smoking (active)..................................................... 

Low Sunlight Exposure (low or none).................... 

Family History of Osteoporotic Fracture................ 

Low Calcium Intake (<500-850 mg/day)................ 

Hyperparathyroidism (N/S) .................................... 

Hyperthyroidism ..................................................... 

Diabetes mellitus (type II or N/S)........................... 

Rheumatoid arthritis................................................ 

UNCLASSIFIABLE RISK FACT

Alcohol Intake.......................................

Male hypogonadism..............................

Other hormonal factors in men, includin Anti-androgen therapy .........

Prostaglandin inhibitors (NSAIDs and a

Anti-ulcer agents...................................

Thyroid disease including replacement 

Respiratory diseases – independent of s

Dietary deficiency of Vitamin D...........

Metabolism and GI absorption disorder

SCI ........................................................

Hyperhomocysteinemia ........................

 This article does not include any of  listed on this form.

Article ID: Reviewer: Elaine Wong

First Author: ____________________________________ 

 (Last Name Only) 
VA Male OP Project-Detailed Review Form- RISK FACTOR STUDIES

54 

STUDY PARTICIPATION 

YES NO 

Was the source population clearly defined?... 

Was the study population described?............. 

Is the study population representative of  the patients of interest (VA)?.....................  

STUDY DESIGN 

 4. What is the study design? (Check one) 

Case- Control ..........................................................



Cohort .....................................................................



Cross sectional ........................................................



STUDY ATTRITION

 FOR COHORTS ONLY How many subjects were enrolled?  _____ _____ _____ _____ (ND=9999)  6. How many subjects were included in the data analysis?  _____ _____ _____ _____ (ND=9999) 

 7. What is the duration of the follow up? 

 Duration Units 

 OR 

 _____ _____ _____ _____ person-years 

 FOR CASE CONTROL ONLY  8. How many cases were included?  _____ _____ _____ _____  9. How many controls were included?  _____ _____ _____ _____  FOR CROSS SECTIONAL STUDIES ONLY 

10. What is the sample size? 

 _____ _____ _____ _____ 

RISRIRISK FACTOR MEASUREMENT

Which of the following risk factors were asse

Alcohol Consumption .......................

- If yes, how was alcohol consu____________________________

Diabetes Mellitus, type II or NOS ....

- If yes, how was the presence o____________________________

Spinal Cord Injury.............................

- If yes, how was the presence a____________________________

 Article ID: Reviewer: First Author: ____________________________________ 

(Last Name Only) 

F

Units

01. Days 04. Years 02. Weeks 05. NR 03. Months 
VA Male OP Project-Detailed Review Form- RISK FACTOR STUDIES

55 

OUTCOME MEASUREMENT

 12. What outcome was assessed? 

BMD (cDXA).........................................................  

 If yes answer the following: 

- Site (CHECK ALL THAT APPLY)

 Spine ..........................................................



 Femur .........................................................



 Radius ........................................................



 Patella.........................................................



 Calcaneus ...................................................



 Finger .........................................................



 Other: ________________________ .......   Not applicable ............................................



 Not reported ...............................................  

- T-score: _____________________________ - Reference Standard 

 Male ...........................................................



 Female........................................................



 Other .........................................................  

Specify:___________________________ 

Osteoporotic fracture............................................  

If yes, how was the presence of fracture assessed: 

(CHECK ALL THAT APPLY)

 X-ray ..........................................................



 Diary/Self Report.......................................



 Administrative data....................................



 Medical Record Review.............................



Other Bone Measurements...................................   If yes, please specify: (CHECK ALL THAT APPLY)

 Ultrasound..................................................



 Other .........................................................  

Specify:___________________________ 

POTEPOTENTIAL CONFOUNDING PROGNOS

MEASUREMENT 13. Which of the following risk facto

Age....................................................

Low body weight ..............................

Weight loss........................................

Physical inactivity/prolonged immob (Not SCI).........................

Corticosteroid use .............................

Anticonvulsant use............................

Hyperparathyroidism ........................

Diabetes Mellitus, type I ...................

Gastrectomy ......................................

Hypogonadism, primary or secondary 

Poor visual acuity..............................

Previous osteoporotic fracture ..........

Cigarette smoking .............................

Vitamin D deficiency........................

Low dietary calcium intake...............

Family History of Osteoporotic Fract

Hyperthyroidism ...............................

Rheumatoid Arthritis ........................

High bone turnover rate ....................

ANALANALYSIS

14. Does the article present: 

Bivariate............................................Multivariate.......................................Other ................................................

Specify:_______________
VA Male OP Project – RISK FACTOR STUDIES, Quality Measurement 

56 

STUDY PARTICIPATION The study sample represents the population of interest on key characteristics, sufficient to limit potential bias to the results. 

 Yes ........................................................................

 Partly..................................................................... 

 No.......................................................................... 

 Unsure................................................................... 

*Population of interest is adequately described for key characteristics *Sampling frame and recruitment are adequately described, including methods to identity the sample (number and type used, e.g., referral patterns in health care), period of recruitment, and place of recruitment (setting and geographic location). *Inclusion and exclusion criteria are adequately described (e.g., including explicit diagnostic criteria or “zero time” description). * There is adequate participation in the study by eligible individuals. *The baseline study sample (i.e., individuals entering the study) is adequately described for key characteristics. 

STUDY ATTRITIONLoss to follow-up (from sample to study population) is not associated with key characteristics (i.e., the study data adequately represent the sample), sufficient to limit potential bias. 

 Yes ........................................................................ 

 Partly..................................................................... 

 No.......................................................................... 

 Unsure................................................................... 

*Proportion of study sample completing the study and providing outcome data is adequate. 

*Attempts to collect information on participants who dropped out of the study are described. *Reasons for loss to follow-up are provided. *Participants lost to follow-up are adequately described for key characteristics. *There are no important differences between key characteristics and outcomes in participants who completed the study and those who did not. 

PROGPROGNOSTIC FACTOR MEASUREMENT

The prognostic factor of interest is adequately measuresufficiently limit potential bias. 

 Yes.................................................................

 Partly..............................................................

 No ..................................................................

 Unsure............................................................

*A clear definition or description of the prognostic factor measure is level, duration of exposure, and clear specification of the method of m*Continuous variables are reported or appropriate (i.e., not data-depe*The prognostic factor measure and method are adequately valid and 

Bias (e.g. may include relevant outside sources of information on mecharacteristics, such as blind measurement and limited reliance on rec*Adequate proportion of the study sample has complete data for prog*The method and setting of measurement are the same for all study p*Appropriate methods are used if imputation is used for missing prog

OUTCOME MEASUREMENT

The outcome of interest is adequately measured in studsufficiently limit potential bias. 

 Yes.................................................................

 Partly..............................................................

 No ..................................................................

 Unsure............................................................

 *A clear definition of the outcome of interest is provided, including d and extent of the outcome construct. 

*The outcome measure and method used are adequately valid and rel

(e.g., may include relevant outside sources of information on measurecharacteristics, such as blind measurement and confirmation of outco*The method and setting of measurement are the same for all study p

Article ID: Reviewer: 

First Author: ____________________________________ 

 (Last Name Only) 
VA Male OP Project – RISK FACTOR STUDIES, Quality Measurement 

57 

CONFOUNDING MEASUREMENT AND ACCOUNT

Important potential confounders are appropriately accounted for, limiting potential bias with respect to the prognostic factor of interest. 

 Yes ........................................................................

 Partly..................................................................... 

 No.......................................................................... 

 Unsure................................................................... 

*All important confounders, including treatments (key variables in conceptual model), are measured. *Clear definitions of the important confounders measured are provided (e.g., including dose, level and duration of exposures). *Measurement of all important confounders is adequately valid and reliable (e.g., may include relevant outside sources of information on measurement properties, also characteristics, such as blind measurement and limited reliance on recall.) *The method and setting of confounding measurement are the same for all study participants. *Appropriate methods are used if imputation is used for missing confounder data. *Important potential confounders are accounted for in the study design (e.g., matching for key variables, stratification, or initial assembly of comparable groups.) *Important potential confounders are accounted for in the analysis (i.e., appropriate adjustment). 

ANALYSIS

The statistical analysis is appropriate for the design of potential for presentation of invalid results. 

 Yes.................................................................

 Partly..............................................................

 No ..................................................................

 Unsure............................................................

*There is sufficient presentation of data to assess the adequacy of the *The strategy for model building (i.e., inclusion of variables) is approframework or model. * The selected model is adequate for the design of the study. *There is no selective reporting of results. 
58 

Appendix B. Evidence Table 
Evidence Table 1. Diagnostic Test Studies 

Columns 1-10: Article, Population, Characteristics, Sample Size, Study test & site, Reference test & site, QUADAS, R

*QUADAS 1=Yes, 2=No, 3=Unclear; Order is: Spectrum representativeness, Selection criteria, Reference standard, Time period, Verification bias, Use of same reference test, Independe

reference test, Blinding #1, Blinding #2, Usefulness in practice, Intermediate results, Withdrawls NR=Not Reported BUA=Broad-band ultrasound attenuation QUI=Quantitative Ultrasound Index DXA=Dual energy x-ray absorptiometry 

SOS=Speed of sound OST=Osteoporosis Screening Tool BMD=Bone Mass Density QUS=Quantitative Ultrasound SI=Stiffness Index OSTA=Osteoporosis Screening Tool for Asians MOST=Male Osteoporosis Screening Tool AVU=Apparent velocity of ultrasound 

Study Reference 

Author, Year, Region, 

Trial Name Population Characteristics 

Male 

sample 

size Test Site Test Site QUADAS* 

Adler, 2001 27

US/Canada 

Referred for DXA NR, Veteran 185 Ultrasound BUA 

& QUI 

Calcaneus Central DXA Spine, Femur 3,3,1,1,1,1,1, 

1,1,3,3,1,1,3 

Adler, 2003 19US/Canada 

Pulmonary Clinic Asian, Veteran 107 Ultrasound BUA, 

SOS & QUI; questionnaire 

Calcaneus Central DXA Spine, Femur 1,1,1,1,2,1,1, 

1,1,3,3,1,1,3 

Adler, 2003 35

US/Canada 

Pulmonary & Rheumatology Clinic 

Pulmonary & Rheumatology Clinic, Veteran 

181 Questionnaire 

OST 

NA Central DXA Spine, Femur 1,1,1,1,1,1,1, 

1,1,3,3,1,1,1 

Cheng, 1997 95Scandinavia 

Elderly NR 205 Peripheral bone 

density pDXA 

Calcaneus Fracture 

Occurrence 

Multiple Sites 2,1,1,1,2,1,1, 

1,1,3,3,1,1,1 

De Laet, 1998 96

Western Europe 

Elderly NR 2778 Central DXA, 

Hiefy Risk using DCA 

Femur, NA Fracture 

Occurrence 

NA 1,1,1,1,1,1,1, 

1,1,3,3,1,1,1 

Donaldson, 1999 72Western Europe 

Elderly NR 817 Ultrasound BUA Calcaneus Fracture 

Occurrence 

NR 1,1,3,1,2,3,1, 

1,1,3,3,1,1,2 
Evidence Table 1. Diagnostic Test Studies 

Columns 1-10: Article, Population, Characteristics, Sample Size, Study test & site, Reference test & site, QUADAS, R

*QUADAS 1=Yes, 2=No, 3=Unclear; Order is: Spectrum representativeness, Selection criteria, Reference standard, Time period, Verification bias, Use of same reference test, Independe

reference test, Blinding #1, Blinding #2, Usefulness in practice, Intermediate results, Withdrawls NR=Not Reported BUA=Broad-band ultrasound attenuation QUI=Quantitative Ultrasound Index DXA=Dual energy x-ray absorptiometry 

SOS=Speed of sound OST=Osteoporosis Screening Tool BMD=Bone Mass Density QUS=Quantitative Ultrasound SI=Stiffness Index OSTA=Osteoporosis Screening Tool for Asians MOST=Male Osteoporosis Screening Tool AVU=Apparent velocity of ultrasound 

Study Reference 

Author, Year, Region, Population Characteristics

Male 

sample 

size Test Site Test Site QUADAS* 

Gonnelli, 2005 68

Western Europe 

Bone Clinic NR 407 Ultrasound BUA 

& SOS; Central DXA 

Spine, Femur, Calcaneus 

Fracture Occurrence 

Spine, Femur, Radius, Pelvis 

2,1,1,1,1,1,1, 1,1,3,3,1,1,1 

Grampp, 2001 66Western Europe 

Referred for BMD NR 501 Ultrasound QUS Calcaneus Central DXA Spine, Femur 2,1,1,1,1,1,1, 

1,1,3,3,1,1,1 

Gudmundsdottir, 2005 20

Scandinavia 

Unselected NR 589 Ultrasound BUA, 

SOS & SI 

Calcaneus Central DXA Spine, Femur 2,1,1,1,3,1,1, 

1,1,3,3,1,1,2 

Kaptoge, 2004 17Western Europe 

Unselected NR 2653 Simple Score 

Male Multivariate Model 

Spine Fracture 

Occurrence 

Spine, Femur, Radius, Rib, Other 

1,1,1,1,1,1,1, 1,1,3,3,1,1,1 

Karlsson, 1996 14

Scandinavia 

Unselected NR 33 Central DXA; Xray Femur Fracture Occurrence Femur 1,1,1,1,1,1,1, 1,1,3,3,3,1,1 

Kroger, 1999 97Scandinavia, Western Europe 

Referred – PCP NR 68 Central DXA; 

Quantitative CT 

Spine, Femur Fracture 

Occurrence 

Spine, Femur 3,2,1,3,3,3,1, 

1,1,3,3,3,3,3 

Kung, 2005 63

Asia 

Elderly Asian 776 Ultrasound BUA; 

SOS & QUI; OSTA 

Calcaneus NA 

Central DXA Spine, Femur 2,1,1,1,1,1,1, 

1,1,3,3,1,1,3 

Li-Yu, 2005 15Asia 

Unselected Filipino 132 OSTA NA Central DXA Femur 2,1,1,1,1,1,1, 

2,1,3,1,1,3,3 

Lynn, 2005 65

Asia 

Elderly Asian 2000 Ultrasound QUI; 

MOST 

NA Central DXA Spine, Femur 2,1,1,1,3,1,1, 

1,1,3,3,1,1,3 

Melton, 2005 98US/Canada 

Unselected NR 348 Bone Structural 

Parameters 

Femur Central 

DXA, Fracture Occurrence 

Femur 1,1,1,1,1,1,2, 

1,1,3,3,1,1,2 

Montagnani, 2001 67Western Europe 

Unselected NR 182 Central DXA; 

Ultrasound 

Spine, Femur, Finger 

Fracture Occurrence 

NR 1,2,1,1,1,1,1, 

1,1,3,3,1,1,1 
Evidence Table 1. Diagnostic Test Studies 

Columns 1-10: Article, Population, Characteristics, Sample Size, Study test & site, Reference test & site, QUADAS, R

*QUADAS 1=Yes, 2=No, 3=Unclear; Order is: Spectrum representativeness, Selection criteria, Reference standard, Time period, Verification bias, Use of same reference test, Independe

reference test, Blinding #1, Blinding #2, Usefulness in practice, Intermediate results, Withdrawls NR=Not Reported BUA=Broad-band ultrasound attenuation QUI=Quantitative Ultrasound Index DXA=Dual energy x-ray absorptiometry 

SOS=Speed of sound OST=Osteoporosis Screening Tool BMD=Bone Mass Density QUS=Quantitative Ultrasound SI=Stiffness Index OSTA=Osteoporosis Screening Tool for Asians MOST=Male Osteoporosis Screening Tool AVU=Apparent velocity of ultrasound 

Study Reference 

Author, Year, Region, Population Characteristics

Male 

sample 

size Test Site Test Site QUADAS* 

Mulleman, 2002 [#1274] Western Europe 

Referral NR 102 Ultrasound BUA, 

SOS & SI 

Calcaneus Central 

DXA, Fracture Occurrence 

Spine, Femur 2,1,3,1,1,1,1, 

1,1,3,3,1,1,1 

Odvina, 1988 99US/Canada 

Referral for Osteoporosis 

NR, Veteran 38 Quantitative CT Spine Fracture 

Occurrence 

2,1,1,1,1,1,1, 1,1,3,3,1,1,1 

Robinson, 1987 100

Australia 

Referred by Hospital Staff 

NR 31 Linear Photon 

Absorptiometry 

Spine, Radius 

Quantitative CT, Fracture Occurrence 

Spine 2,2,1,1,3,3,1, 

1,1,3,3,1,1,3 

Rothenberg, 2004 70US/Canada 

Unselected NR 301 Ultrasound Bone 

Density 

Calcaneus Fracture 

Occurrence 

Spine, Femur, Radius, Shoulder, Ribs 

1,1,3,1,1,1,1, 1,1,3,3,1,1,1 

Shin, 2005 101

Asia 

Unselected, Elderly 

Asian 1225 Ultrasound BUA, 

SOS & Stiffness 

Calcaneus Peripheral 

bone density pDXA 

Radius, Calcaneus 2,1,1,1,1,1,1, 

1,1,3,3,1,1,2 

Stewart, 1995 73Western Europe 

Unselected NR 247 Ultrasound BUA; 

Central DXA 

Spine, Femur, Calcaneus 

Fracture Occurrence 

Spine 1,3,1,1,1,1,1, 

1,1,3,3,1,1,1 

Travers-Gustafson, 1995 74

US/Canada 

Elderly NR 529 Peripheral Bone 

Density other; AVU 

Radius, Patella 

Fracture Occurrence 

NR 1,1,3,1,1,1,1, 

1,1,3,3,1,1,1 
Evidence Table 1. Diagnostic Test Studies 

Columns 1-10: Article, Population, Characteristics, Sample Size, Study test & site, Reference test & site, QUADAS, R

*QUADAS 1=Yes, 2=No, 3=Unclear; Order is: Spectrum representativeness, Selection criteria, Reference standard, Time period, Verification bias, Use of same reference test, Independe

reference test, Blinding #1, Blinding #2, Usefulness in practice, Intermediate results, Withdrawls NR=Not Reported BUA=Broad-band ultrasound attenuation QUI=Quantitative Ultrasound Index DXA=Dual energy x-ray absorptiometry 

SOS=Speed of sound OST=Osteoporosis Screening Tool BMD=Bone Mass Density QUS=Quantitative Ultrasound SI=Stiffness Index OSTA=Osteoporosis Screening Tool for Asians MOST=Male Osteoporosis Screening Tool AVU=Apparent velocity of ultrasound 

Author, Year, Region, Population Characteristics Male Study Reference sample 

size Test Site Test Site QUADAS* 

Varenna, 2005 69

Western Europe 

Unselected NR 4832 Ultrasound BUA, 

SOS, & SI 

Calcaneus Fracture 

Occurrence 

Femur, Non-spinal 1,1,3,1,1,1,1, 

1,1,3,3,1,1,1 

Welch, 2004 71Western Europe 

Unselected NR 6860 Ultrasound BUA Calcaneus Fracture 

Occurrence 

Spine, Femur, Radius 

1,1,3,1,1,1,1, 1,1,3,3,1,1,1 

Bauer, 2006 75

US/Canada 

Elderly NR 5608 Ultrasound BUA, 

Central DXA 

Femur, Calcaneus 

Fracture Occurrence 

Femur 1,1,1,1,1,1,1, 

3,3,1,1,1,1,3