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AIDS. 2018 Jul 31;32(12):1699-1706. doi: 10.1097/QAD.0000000000001864.

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

Author information

1
Department of Epidemiology, Columbia University Mailman School of Public Health, New York.
2
Department of Medicine, Albert Einstein College of Medicine, Bronx.
3
Department of Public Health, School of health Sciences and Practice, New York Medical College, Valhalla, New York.
4
Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois.
5
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
6
Department of Neurology, SUNY Downstate Medical Center, Brooklyn, New York.
7
Department of Family Medicine, Georgetown University Medical Center, Washington, District of Columbia.
8
Department of Preventive Medicine, Keck School of Medicine of University of Southern California, Los Angeles.
9
Department of Medicine, University of California, San Francisco.
10
Department of Veterans Affairs Medical Center, San Francisco, California.
11
Department of Medicine, Columbia University Medical Center, New York, New York, USA.

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 of FRAX was evaluated by the observed/estimated ratios of fracture in four models: CRFs alone; CRFs with HIV included as a cause of secondary osteoporosis; CRFs and femoral 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, Pā€Š<ā€Š0.001) and hip fractures (observed/estimated ratio: 19.78 vs. 7.94, Pā€Š<ā€Š0.001), 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 HIV-infected 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.

PMID:
29762165
PMCID:
PMC6126899
[Available on 2019-07-31]
DOI:
10.1097/QAD.0000000000001864

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