Improved fracture prediction using different fracture risk assessment tool adjustments in HIV-infected women

Jingyan Yang, Anjali Sharma, Qiuhu Shi, Kathryn Anastos, Mardge H. Cohen, Elizabeth T. Golub, Deborah Gustafson, Daniel Merenstein, Wendy J. Mack, Phyllis C. Tien, Jeri W. Nieves, Michael T. Yin

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Objectives: A fracture risk assessment tool (FRAX) using clinical risk factors (CRFs) alone underestimates fracture risk in HIV-infected men. Our objective was to determine whether accuracy of FRAX would be improved by considering HIV as a cause of secondary osteoporosis, and further improved with addition of dual-energy X-ray absorptiometry parameters in HIV-infected women. Design: Subgroup analysis of Women's Interagency HIV Study. Methods: We included 1148 women (900 HIV-infected and 248 uninfected) over age 40 with data to approximate FRAX CRFs and 10-year observational data for incident fragility fractures; 181 (20%) HIV-infected women had dual-energy X-ray absorptiometry data. Accuracy ofFRAXwas evaluated by the observed/estimated ratios of fracture in four models: CRFs alone;CRFs withHIVincludedas a causeof secondaryosteoporosis;CRFs andfemoral neck bone mineral density (FN BMD); and CRFs, FN BMD and trabecular bone score. Results: FRAX using CRFs were less accurate in HIV-infected than uninfected women for major osteoporotic (observed/estimated ratio: 5.05 vs. 3.26, P<0.001) and hip fractures (observed/estimated ratio: 19.78 vs. 7.94, P<0.001), but improved when HIV was included as a cause of secondary osteoporosis. Among HIV-infected women, FRAX accuracy improved further with addition of FN BMD (observed/estimated ratio: 4.00) for hip fractures, but no further with trabecular bone score. Conclusion: FRAX using CRFs alone underestimated fracture risk more in older HIVinfected women than otherwise similar uninfected women. Accuracy is improved when including HIV as a cause of secondary osteoporosis for both major osteoporotic and hip fractures, whereas addition of FN BMD only improved accuracy for hip fracture.

Original languageEnglish (US)
Pages (from-to)1699-1706
Number of pages8
Issue number12
StatePublished - 2018


  • Bone mineral density
  • Fracture
  • Fracture risk assessment tool
  • HIV infection
  • Secondary osteoporosis
  • Trabecular bone score

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases


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