Background. Osteoporosis is a devastating, insidious disease that causes skeletal fragility. Half of women will suffer osteoporotic fractures during their lifetimes. Many fractures occur needlessly, because of inattentiveness to assessment, diagnosis, prevention, and treatment of osteoporosis. Study Purpose. Study Purpose. To evaluate the discriminatory performance of clinical decision rules to determine the need to undergo bone mineral density testing. Methods. A nationally representative sample from the Third National Health and Nutrition Examination Survey consisted of 14,060 subjects who completed surveys, physical examinations, laboratory tests, and bone mineral density exams. Multivariable linear regression tested the correlation of covariates that composed the clinical decision rules with bone mineral density. Results. Increased age and decreased weight were variables in the final regression models for each gender and race/ethnicity. Among the indices, the Osteoporosis Self-Assessment Tool, which is composed of age and weight, performed best for White women. Study Implications. These results have implications for the prevention, assessment, diagnosis, and treatment of osteoporosis. The Osteoporosis Self-Assessment Tool performed best and is inexpensive and the least time consuming to implement. 1. Introduction Osteoporosis is a devastating, insidious chronic disease that causes skeletal fragility. Half of women and one-eighth of men will suffer osteoporotic fractures during their lifetimes [1–3]. The occurrence of disability following osteoporotic hip fracture exceeds that of stroke, heart disease, or cancer and often leads to a profound forfeiture of independence [4–8]. Among people one year after the occurrence of hip fracture, seven in 10 are unable to walk independently, eight in 10 are unable to perform instrumental functions such as driving or shopping, and one-third of those residing in a nursing home had been living in a residence other than a nursing home prior to hip fracture [9–11]. Sequelae of hip fractures, such as pneumonia and pulmonary embolism, are frequently lethal [1]. One in four people die during the year subsequent to hip fracture, and one-third of these deaths are attributable to hip fracture [9, 12, 13]. Indeed, falls are the leading cause of injury-related death among people aged 65 years and older in the US [14]. Though men have a lower incidence of hip fractures than women, they are twice as likely to die in the year afterward [15]. People are also living longer. The World Health Organization’s (WHO) health profile of
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