Abstract
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 language | English (US) |
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Pages (from-to) | 1699-1706 |
Number of pages | 8 |
Journal | AIDS |
Volume | 32 |
Issue number | 12 |
DOIs | |
State | Published - 2018 |
Keywords
- 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