Department of Epidemiology, Columbia University Mailman School of Public Health, New York.
Department of Medicine, Albert Einstein College of Medicine, Bronx.
AIDS. 2018 Jul 31;32(12):1699-1706. doi: 10.1097/QAD.0000000000001864.
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.
Subgroup analysis of Women's Interagency HIV Study.
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.
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.
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.
使用临床危险因素（CRFs）的骨折风险评估工具（FRAX）低估了 HIV 感染男性的骨折风险。我们的目的是确定考虑 HIV 为继发性骨质疏松症的原因是否会提高 FRAX 的准确性，并且在 HIV 感染女性中加入双能 X 射线吸收法参数后进一步提高准确性。
妇女艾滋病研究机构间研究的亚组分析。
我们纳入了 1148 名年龄在 40 岁以上的女性（900 名 HIV 感染和 248 名未感染），这些女性有数据可以近似 FRAX CRFs 和 10 年的脆性骨折观察数据；181 名（20%）HIV 感染女性有双能 X 射线吸收法数据。我们通过四个模型评估了 FRAX 的准确性：仅使用 CRFs；将 HIV 作为继发性骨质疏松症的原因纳入 CRFs；CRFs 和股骨颈骨密度（FN BMD）；以及 CRFs、FN BMD 和小梁骨评分。
与未感染女性相比，HIV 感染女性的 FRAX 使用 CRFs 预测主要骨质疏松性（观察/估计比值：5.05 比 3.26，P < 0.001）和髋部骨折（观察/估计比值：19.78 比 7.94，P < 0.001）的准确性较差，但当将 HIV 纳入继发性骨质疏松症的原因时，准确性有所提高。在 HIV 感染女性中，加入 FN BMD（观察/估计比值：4.00）后，FRAX 预测髋部骨折的准确性进一步提高，但加入小梁骨评分后则没有进一步提高。
与无感染女性相比，单独使用 CRFs 的 FRAX 对年龄较大的 HIV 感染女性低估了骨折风险。当将 HIV 作为继发性骨质疏松症的原因时，对主要骨质疏松性和髋部骨折的准确性都有所提高，而加入 FN BMD 仅提高了髋部骨折的准确性。
