FRAX assessment in people ageing with HIV

• Published in: HIV medicine Vol. 23; no. 1; pp. 103 - 108
• Main Authors: Mazzitelli, Maria, Branca Isabel, Pereira, Muramatsu, Takashi, Chirwa, Mimie, Mandalia, Sundhiya, Moyle, Graeme, Marta, Boffito, Milinkovic, Ana
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.01.2022
• Subjects: Absorptiometry, Photon - methods; Age; Aging; Algorithms; Biomedical materials; Body mass; Body mass index; Body size; Bone Density; Bone mineral density; Cross-Sectional Studies; Density measurement; Dual energy X-ray absorptiometry; Female; fracture risk; Fractures; FRAX; Glomerular filtration rate; HIV; HIV Infections - complications; Human immunodeficiency virus; Humans; Male; Middle Aged; Multiple regression models; Osteopenia; Osteoporosis; Patients; PLWH; Regression analysis; Risk analysis; Risk assessment; Risk Assessment - methods; Risk Factors; PLWH; FRAX; HIV; osteoporosis; fracture risk
• ISSN: 1464-2662; 1468-1293
• DOI: 10.1111/hiv.13170

Objectives Current British HIV Association (BHIVA) guidelines recommend the use of FRAX for the routine assessment of bone fracture risk in people living with HIV over 50 years of age every 3 years. Bone mineral density measurement with dual‐energy X‐ray absorptiometry (DXA) scan is recommended for those with increased fracture risk (FRAX major > 10%). Our objectives were to estimate the prevalence of and risk factors for osteoporosis in a population of PLWH aged > 50 years and assess the utility of FRAX in predicting the presence of DXA‐proven osteoporosis in this cohort. Methods This was a cross‐sectional study of a cohort of PLWH aged > 50 years attending the Chelsea and Westminster Hospital and who had a DXA scan between January 2009 and December 2018. FRAX scores were calculated using the Sheffield algorithm. Multiple regression models and Cohen's kappa values were used to assess risk factors for osteoporosis and agreement between FRAX and DXA scan results, respectively. Results In all, 744 patients were included (92.9% male, mean age 56 ± 5 years). The prevalence rates of osteoporosis (at DXA scans) and osteopenia were 12.2% and 63.7%, respectively. FRAX major was > 10% in only two patients, while 90/91 (98.9%) patients with osteoporosis had a normal FRAX score. The presence of osteoporosis was significantly associated with low body mass index and estimated glomerular filtration rate (p < 0.05). Conclusion Our results indicate that FRAX scores did not predict the presence of osteoporosis in our population of PLWH over 50 years of age and therefore FRAX scores may not be the appropriate tool to define eligibility to perform DXA scans in PLWH.