Improved Fracture Prediction Using Different Fracture Risk Assessment Tool Adjustments in HIV-Infected Women
Epidemiology and Community Health
OBJECTIVES: A Fracture risk assessment tool (FRAX(R)) 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 DXA 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 DXA data. Accuracy of FRAX was evaluated by the observed/estimated (O/E) ratios of fracture in 4 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 (TBS). RESULTS: FRAX using CRFs were less accurate in HIV-infected than uninfected women for major osteoporotic (O/E ratio: 5.05 vs 3.26, p < 0.001) and hip fractures (O/E 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 (O/E ratio: 4.00) for hip fractures, but no further with TBS. CONCLUSIONS: 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, while addition of FN BMD only improved accuracy for hip fracture.
Yang, J., Sharma, A., Shi, Q., Anastos, K., Cohen, M., Golub, E., Gustafson, D., Merenstein, D., Mack, W., Tien, P., Nieves, J., & Yin, M. (2018). Improved Fracture Prediction Using Different Fracture Risk Assessment Tool Adjustments in HIV-Infected Women. AIDS, 31 (12), 1699-1706. https://doi.org/10.1097/QAD.0000000000001864