Epidemiology and Social

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

Yang, Jingyan^a; Sharma, Anjali^b; Shi, Qiuhu^c; Anastos, Kathryn^b; Cohen, Mardge H.^d; Golub, Elizabeth T.^e; Gustafson, Deborah^f; Merenstein, Daniel^g; Mack, Wendy J.^h; Tien, Phyllis C.^i,j; Nieves, Jeri W.^a; Yin, Michael T.^k

Author Information

^aDepartment of Epidemiology, Columbia University Mailman School of Public Health, New York

^bDepartment of Medicine, Albert Einstein College of Medicine, Bronx

^cDepartment of Public Health, School of health Sciences and Practice, New York Medical College, Valhalla, New York

^dDepartment of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois

^eDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

^fDepartment of Neurology, SUNY Downstate Medical Center, Brooklyn, New York

^gDepartment of Family Medicine, Georgetown University Medical Center, Washington, District of Columbia

^hDepartment of Preventive Medicine, Keck School of Medicine of University of Southern California, Los Angeles

ⁱDepartment of Medicine, University of California, San Francisco

^jDepartment of Veterans Affairs Medical Center, San Francisco, California

^kDepartment of Medicine, Columbia University Medical Center, New York, New York, USA.

Correspondence to Michael T. Yin, Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, 630 W 168th Street, New York, NY 10032, USA. E-mail: [email protected]

Received 28 January, 2018

Revised 21 April, 2018

Accepted 3 May, 2018

AIDS 32(12):p 1699-1706, July 31, 2018. | DOI: 10.1097/QAD.0000000000001864

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, 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 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.

Article Keywords

Keywords
bone mineral density, fracture, fracture risk assessment tool, HIV infection, secondary osteoporosis, trabecular bone score

Secondary Logo

Journal Logo

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