BackgroundPatients infected with the human immunodeficiency virus (HIV) have a high rate of low bone mineral density (BMD) and is thought to be multifactorial. Some instruments have been developed to estimate the risk of osteoporotic fracture in the general population such as the WHO Fracture Risk Assessment Tool (FRAX), which allows calculating the 10-year probability of fractures in men and women from clinical risk factors with or without the measurement of femoral neck BMD. The cut-off values for high risk of hip fracture >3% and for major osteoporotic fracture >20%. Although FRAX has been validated in multiple large cohorts, still there are no clear recommendations of its use in HIV-infected patients older than 50 years.ObjectivesTo evaluate the utility of FRAX tool in the prediction of risk of vertebral morphometric deformity (MVD) in HIV-infected patients over 50 years old seen in a Spanish tertiary care center.MethodsWe performed a cross-sectional study in HIV-infected patients with age 50 years treated in our centre during the period 2014–2016. Demographics and risk factors were collected through a specific survey. FRAX was calculated adding HIV as a cause of secondary osteoporosis in all patients with and without BMD measured by dual-energy X-ray absorptiometry scan (DXA). The MVD were assessed using the Genant's semiquantitative method. The sensitivity and specificity of the test were assessed and correlations made with the presence of MVD.ResultsA total of 121 patients were included, 34 women (28%), with a mean age of 54.1 years (range: 50–75). MVD was detected in 25 cases (21%). The patients presented with a mean BMI of 23.7 kg/m2, 33% were smokers, 7% had a consumption of ≥3 doses of alcohol per day, 9% had a family history of hip fracture but no patient presented with previous history of fracture, corticoid treatment or rheumatoid arthritis. The mean FRAX score for major osteoporotic fracture without BMD was of 2.29 (1.1–8.5), there were 2 patients above 7 and any above 10; the mean FRAX score for hip fracture without BMD was of 0.64 (0.1–3.9), 2 patients were above 3. With DXA, osteoporosis in femoral neck was detected in 8% and in the lumbar spine in 30%, while femoral neck osteopenia was detected in 64% and in the lumbar spine in 45%. Including DXA data, the mean FRAX score for major osteoporotic fracture was 2.52 (0.2–8.2), 2 patients were above 7, and for hip fracture the mean FRAX score was 0.67 (0.01–4.4), with 2 patients above 3. The values of FRAX with DXA or without DXA were very similar, with a variation of -0.4 for the mean value of major osteoporotic fracture and +0.03 for the mean value of hip fracture. In ROC curve, a value above 1 in FRAX for hip fracture with DXA, detected 9 MVD of 29 patients (sensitivity 38%, specificity 80%), a value above 2 detected 4 MVD of 10 patients (sensitivity 17%, specificity 93%) and a value of 3 detected 1 MVD of 2 patients (sensitivity 4%, specificity 99%).ConclusionsThe FRAX tool does not identify properly the HIV-infected patients older than 50 years ...

virus infection was present in 29%. 25% were treated with tenofovir plus protease inhibitors, and 47% with tenofovir plus a non-nucleoside reverse transcriptase inhibitor. The mean value of BMD in lumbar spine (LS) was 0.93 g/cm 2 (range: 0.84-1.02) and in femoral neck (FN) 0.78 g/cm 2 (range: 0.69-0.86). For the comparison with the ESOSVAL cohort the worst value of T-score in either LS or FN was chosen and patients were classified according to WHO definitions (osteoporosis ≤-2.5, osteopenia-1 to-2.5); the results are presented in the table. Only the data for the 50-64 and 65-74 years groups were compared because the number of older HIV patients in our center was small. Significant differences were found between the categories of osteoporosis in men in the 65-74 years old group, and that of osteopenia in women in the 55-64 years old group.

BackgroundPatients with human immunodeficiency virus (HIV) have a higher prevalence of low bone mineral density (BMD) and fractures than the general population, but there are no comparative studies in Spanish population.ObjectivesTo assess the BMD in HIV-infected patients followed in a tertiary hospital of Madrid and compare it with the ESOSVAL cohort, which included 11035 patients and is representative of non-HIV population seen in Spanish tertiary centers.MethodsWe performed a cross-sectional study in which BMD values were determined in a prospective cohort that included HIV-infected patients seen our center during the period 2010–2015. Collected data included demography, comorbidities, treatment and densitometric variables.Results93 patients from a total of a total of 924 with BMD data were eligible for the study after discarding those younger than 55 years, because that group is not included in the ESOSVAL cohort. Mean age of patients of our whole cohort was 43.8 years (range: 17–83), 11% were older than 55 years, of whom 83 were men (83%). Most of them were Caucasians, with a mean body mass index 24.1 (range: 14,7–40.6). Median time of HIV infection was 162,6 months (interquartile range [IQR]: 77.7- 283,3), median CD4+ cells nadir was 224 (IQR: 100–332) and median maximun viral load was 4,9 log (IQR: 4,3–5,4); concomitant hepatitis C virus infection was present in 29%. 25% were treated with tenofovir plus protease inhibitors, and 47% with tenofovir plus a non-nucleoside reverse transcriptase inhibitor. The mean value of BMD in lumbar spine (LS) was 0.93 g/cm2 (range: 0.84–1.02) and in femoral neck (FN) 0.78 g/cm2 (range: 0.69–0.86). For the comparison with the ESOSVAL cohort the worst value of T-score in either LS or FN was chosen and patients were classified according to WHO definitions (osteoporosis ≤ -2.5, osteopenia -1 to -2.5); the results are presented in the table. Only the data for the 50–64 and 65–74 years groups were compared because the number of older HIV patients in our center was small. Significant differences were found between the categories of osteoporosis in men in the 65–74 years old group, and that of osteopenia in women in the 55–64 years old group.55–64y p-value65–74y p-value HIV+ESOSVALHIV+ESOSVAL n=60n=2893n=16n=1555 Males T-score ≤ -2,520%12.6%0.0879844%11.2%0.00005* T-score -1 to -2,561%48.9%0.02888*63%59.2%0.79102Females T-score ≤ -2,531%21%0.3884550%29,8%0.37768 T-score -1 to -2,582%50.1%0.01296*50%49,7%0.99107ConclusionsWe observed a statistically significant increase in prevalence of osteoporosis in HIV-infected men in the 65–74 years group, and in osteopenia HIV-infected men in the 55–64 years group, in concordance with the presumed greater risk derived from a variety of causes (treatment, chronic inflammatory status, comorbidities, etc.). A non significant trend towards an increased prevalence of osteoporosis in the 55–64 years group, and in osteopenia in the 65–74 years group was seen. As for women, there was a statistically significant increase in osteopenia prevalence in ...