Prevalence and Predictors of Low Bone Mineral Density and Fragility Fractures Among HIV-Infected Patients at One Italian Center After Universal DXA Screening: Sensitivity and Specificity of Current Guidelines on Bone Mineral Density Management

Mazzotta, Elena; Ursini, Tamara; Agostinone, Adriana; Nicola, Angelo Domenico Di; Polilli, Ennio; Sozio, Federica; Vadini, Francesco; Pieri, Alessandro; Trave, Francesca; Francesco, Valerio De; Capasso, Lorenzo; Borderi, Marco; Manzoli, Lamberto; Viale, Pierluigi; Parruti, Giustino

doi:10.1089/apc.2014.0205

Cited by 19 publications

(13 citation statements)

References 48 publications

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“…Using their proposed strategy, which combines age, BMI and CD4+ T cell count, the sensitivity and specificity increased to 65% and 67%, respectively 26 . On the other hand, Mazzotta et al found in their cohort of 163 HIV+ adults (mean age 44, 71% men) that following the Italian DXA screening guideline for screening anyone with 2 risk factors other than HIV resulted in only a sensitivity of 32% and specificity of 81% for detecting a Z score≤−2.0 27 .…”

Section: Data On Fracture Risk Calculators In Hiv-infected Individualsmentioning

confidence: 96%

How to predict the risk of fracture in HIV?

Yin

Falutz

2016

Current Opinion in HIV and AIDS

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Purpose of review Skeletal fractures are more common in HIV, and impact the medical, functional and economic status of frequently vulnerable patients. Identifying asymptomatic patients with low bone mineral density (BMD)/osteoporosis requiring intervention can be expected to reduce fracture risk and complications. Clinical tools are available to determine fracture risk in the general population and are being evaluated in HIV patients. The FRAX calculator, incorporating demographics and risk factors for osteoporosis, with or without BMD results, has been investigated most often in HIV patients. Recent findings The few published studies which have calculated the 10-year FRAX risk for both major osteoporosis and hip fractures without BMD generally show limited precision in predicting the presence of osteoporosis severe enough to initiate treatment. It remains uncertain whether using HIV as a secondary risk factor and adding DXA-BMD information improves case-finding compared to using DXA results only. Not incorporating risks relevant to aging HIV patients such as antiretroviral exposure, HCV co-infection and history of falls are other potential limitations. Summary Accurate screening tools using clinical risk factors alone to determine fracture risk in HIV are not yet available. Further research and validation studies are necessary.

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Section: Data On Fracture Risk Calculators In Hiv-infected Individualsmentioning

confidence: 96%

How to predict the risk of fracture in HIV?

Yin

Falutz

2016

Current Opinion in HIV and AIDS

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“…Since this report, additional studies have continued to substantiate that low BMD is common in people living with HIV infection whether ART-treated[7*, 8*] or ART-naïve[9**, 10, 11]; and, in some[12**], but not all[13**, 14], comparative studies osteopenia and osteoporosis are more prevalent among HIV-infected individuals when compared with uninfected controls. Of greatest concern, however, are reports of heightened risk for fracture among people living with HIV.…”

Section: Introductionmentioning

confidence: 99%

Bone loss in HIV

Hileman

Eckard

McComsey

2015

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of the review Because of antiretroviral therapy, people are living with HIV infection longer than ever before. As this patient group ages, it is expected that medical co-morbidities such as osteoporosis and fragility fractures will increase. The purpose of this review is to address the epidemiology and what is known regarding the pathogenesis of bone loss in people living with HIV infection with a focus on recently published literature. Recent findings HIV-infected individuals are at increased risk for low bone mineral density and bone fractures. The cause of bone loss in HIV is multifactorial including traditional risk factors some of which disproportionately affect HIV-infected individuals and alterations in bone metabolism due to antiretroviral therapy (ART), HIV viral proteins and chronic inflammation. Lifestyle modification, changing ART, calcium and vitamin D supplementation and pharmacologic treatment for osteoporosis may all be employed to abrogate bone loss in this patient group. Summary Clinicians should be aware of the contributors to bone loss in people living with HIV in order to recognize high risk individuals and to take appropriate steps to address modifiable risk factors to prevent future fracture.

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“…An increase in the incidence of fractures in HIV + individuals was initially reported at the end of the last decade. Since then, several studies have described the incidence of fractures in people living with HIV (Table ) …”

Section: The Hidden Burden Of Fractures In Hiv‐positive Subjectsmentioning

confidence: 99%

“…The reported incidence of fractures at any skeletal site in people living with HIV ranges from 0.1 fractures per 1000 person‐years to 8.4 fractures per 1000 person‐years (Table ) . However, it is important to note that most of the studies were carried out in men with a mean age of between 36 and 56 years (Table ) . Men in this age group usually have a low frequency of fractures, so comparison with an age and sex‐matched population is important.…”

Section: The Hidden Burden Of Fractures In Hiv‐positive Subjectsmentioning

confidence: 99%

“…The skeleton is one of many tissues affected by HIV infection and its treatment. Although the etiology of bone changes remains incompletely understood, prospective and cross‐sectional studies demonstrate that HIV + patients have lower BMD and increased fracture risk compared with the general population . The aim of this review is to describe what is known about the epidemiology, pathogenesis, pathophysiology, and management of bone disease in people living with HIV.…”

Section: Introductionmentioning

confidence: 99%

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The Hidden Burden of Fractures in People Living With HIV

Premaor

Compston

2018

JBMR Plus

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The survival of people living with human immunodeficiency virus (HIV) has increased markedly since the advent of antiretroviral therapy (ART). However, other morbidities have emerged, including osteoporosis. The estimated incidence of fractures at any site in people living with HIV ranges from 0.1 per 1000 person‐years to 8.4 per 1000 person‐years: at least twice that of people without HIV. This increased risk seems to be related to HIV itself and its treatment. Risk factors for bone disease in HIV‐positive (HIV+) subjects include both classical risk factors for osteoporosis and fracture and factors linked to HIV itself, such as inflammation, reconstitution syndrome, low CD4, ART, and co‐infection with hepatitis B and C viruses. The risk of fractures in these individuals can be at least partially assessed by measurement of BMD and the Fracture Risk Assessment Tool (FRAX™). Only alendronate and zoledronic acid have been studied in HIV+ individuals; both show beneficial effects on BMD, although data on fracture reduction are not available. © 2018 The Authors. JBMR Plus Published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

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Prevalence and Predictors of Low Bone Mineral Density and Fragility Fractures Among HIV-Infected Patients at One Italian Center After Universal DXA Screening: Sensitivity and Specificity of Current Guidelines on Bone Mineral Density Management

Cited by 19 publications

References 48 publications

How to predict the risk of fracture in HIV?

How to predict the risk of fracture in HIV?

Bone loss in HIV

The Hidden Burden of Fractures in People Living With HIV

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