Vizcarra Pilar, Moreno Ana, Vivancos María J, Muriel García Alfonso, Ramirez Schacke Margarita, González-Garcia Juan, Curran Adrián, Palacios Rosario, Sánchez Guirao Antonio Jesús, Reus Bañuls Sergio, Moreno Guillén Santiago, Casado José L
Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRyCIS, Madrid, Spain.
CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
J Bone Miner Res. 2023 Oct;38(10):1443-1452. doi: 10.1002/jbmr.4894. Epub 2023 Aug 23.
People with HIV have a higher risk of fracture than the general population. Because of the low performance of the existing prediction tools, there is controversy surrounding fracture risk estimation in this population. The aim of the study was to develop a model for predicting the long-term risk of fragility fractures in people with HIV. We included 11,899 individuals aged ≥30 years from the Spanish HIV/AIDS research network cohort. We identified incident fragility fractures from medical records, defined as nontraumatic or those occurring after a casual fall, at major osteoporotic sites (hip, clinical spine, forearm, proximal humerus). Our model accounted for the competing risk of death and included 12 candidate predictors to estimate the time to first fragility fracture. We assessed the discrimination and calibration of the model and compared it with the FRAX tool. The incidence rate of fragility fractures was 4.34 (95% CI 3.61 to 5.22) per 1000 person-years. The final prediction model included age, chronic kidney disease, and chronic obstructive pulmonary disease as significant predictors. The model accurately predicted the 5- and 10-year risk of fragility fractures, with an area under the receiving operator characteristic curve of 0.768 (95% CI 0.722 to 0.814) and agreement between the observed and expected probabilities. Furthermore, it demonstrated better discrimination and calibration than the FRAX tool, improving the classification of over 35% of individuals with fragility fractures compared to FRAX. Our prediction model demonstrated accuracy in predicting the long-term risk of fragility fractures. It can assist in making personalized intervention decisions for individuals with HIV and could potentially replace the current tools recommended for fracture risk assessment in this population. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
与普通人群相比，感染HIV的人骨折风险更高。由于现有预测工具的性能不佳，该人群骨折风险评估存在争议。本研究的目的是开发一种模型，用于预测感染HIV的人发生脆性骨折的长期风险。我们纳入了西班牙HIV/AIDS研究网络队列中11,899名年龄≥30岁的个体。我们从医疗记录中识别出脆性骨折事件，定义为主要骨质疏松部位（髋部、临床脊柱、前臂、近端肱骨）的非创伤性骨折或偶然跌倒后发生的骨折。我们的模型考虑了死亡的竞争风险，并纳入了12个候选预测因子来估计首次脆性骨折的时间。我们评估了模型的辨别力和校准，并将其与FRAX工具进行比较。脆性骨折的发病率为每1000人年4.34例（95%CI 3.61至5.22）。最终预测模型包括年龄、慢性肾脏病和慢性阻塞性肺疾病作为显著预测因子。该模型准确预测了脆性骨折的5年和10年风险，受试者工作特征曲线下面积为0.768（95%CI 0.722至0.814），观察到的概率与预期概率一致。此外，与FRAX工具相比，它表现出更好的辨别力和校准，将超过35%的脆性骨折个体的分类进行了改进。我们的预测模型在预测脆性骨折的长期风险方面表现出准确性。它可以帮助为感染HIV的个体做出个性化干预决策，并有可能取代目前推荐用于该人群骨折风险评估的工具。©2023作者。《骨与矿物质研究杂志》由Wiley Periodicals LLC代表美国骨与矿物质研究学会（ASBMR）出版。
