The combination of <scp>FRAX</scp> and <scp>A</scp>geing <scp>M</scp>ale <scp>S</scp>ymptoms scale better identifies treated <scp>HIV</scp> males at risk for major fracture

Pepe, Jessica; Isidori, Andrea M.; Falciano, Mario; Iaiani, Giancarlo; Salotti, Alessandra; Diacinti, Daniele; Fiacco, R. Del; Sbardella, Emilia; Cipriani, Cristiana; Piemonte, Sara; Romagnoli, Elisabetta; Lenzi, Andrea; Minisola, Salvatore

doi:10.1111/j.1365-2265.2012.04452.x

Cited by 34 publications

(15 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One specific study suggests that serum total estradiol, but not testosterone is associated with reduced BMD in HIV-infected men [ 117 ]. This study showed that among men with low testosterone, it is only those men that develop an oestrogen deficiency that will have lower BMD, a result which was also evident in other studies [ 118 , 119 ], although some studies found the opposite to be true [ 120 , 121 ].…”

Section: Hivsupporting

confidence: 76%

Bone mineral density in people living with HIV: a narrative review of the literature

Kruger

Nell

2017

AIDS Res Ther

View full text Add to dashboard Cite

Bone health status is largely absent in South Africa, the main reasons being the absence and cost-effectiveness of specific screening equipment for assessing bone mineral density (BMD). Various risk factors seem to play a role, some of which can be modified to change bone health status. Urbanisation is also a public health concern. Changing nutritional, as well as social behaviour, play integral roles in the prevalence and incidence of decreased BMD. Furthermore, human immunodeficiency virus (HIV) specifically, has a negative impact on BMD and although highly active antiretroviral therapy increases the prognosis for HIV-infected individuals, BMD still seem to decrease further. Dual energy X-ray absorptiometry is considered the gold standard for BMD assessment; however, recent developments have provided more cost-effective screening methods, among which heel quantitative ultrasound appears to be the most widely used in resource limited countries such as South Africa.

show abstract

Section: Hivsupporting

confidence: 76%

Bone mineral density in people living with HIV: a narrative review of the literature

Kruger

Nell

2017

AIDS Res Ther

View full text Add to dashboard Cite

show abstract

“…In an analysis of FRAX performance in a cohort of ambulatory men (MrOS study), Ettinger et al found that FRAX without BMD overestimated observed incidence of fracture (O/E ratios 0.7-0.9) and the addition of BMD did not improve the calibration (O/E ratios 0.7-1.1), nor did it consistently improve discrimination 22 . Several smaller studies in HIV-infected individuals have found that FRAX calculated with the addition of BMD underestimated prevalent fractures 9,10 ; however none have evaluated prediction of incident fracture.…”

Section: Discussionmentioning

confidence: 99%

“…There are no definitive data on similar use of FRAX for HIV-infected patients. Recent studies suggest that FRAX underestimates fracture rates in HIV-infected men 9,10 ; however, both studies included men <50 years and compared the FRAX score to either BMD outcomes or prevalent rather than incident fractures.…”

Section: Introductionmentioning

confidence: 99%

Fracture Prediction With Modified-FRAX in Older HIV-Infected and Uninfected Men

Yin

Shiau

Rimland

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

View full text Add to dashboard Cite

Background FRAX® is a validated, computer-based clinical fracture risk calculator that estimates 10-year risk of major osteoporotic (clinical spine, forearm, hip or shoulder) fracture, and hip fracture alone. It is widely used for decision-making in fracture prevention, but may underestimate risk in HIV-infected individuals. Some experts recommend considering HIV a cause of secondary osteoporosis when calculating FRAX in HIV-infected individuals. Methods From the Veterans Aging Study Virtual Cohort (VACS-VC), we included 24451 HIV-infected and uninfected 50-70 year old men with complete data in year 2000 to approximate all but two factors (i.e. history of secondary osteoporosis and parental hip fracture) for modified-FRAX calculation without bone density and 10-year observational data for incident fragility fracture. Accuracy of the modified-FRAX calculation was compared by observed/estimated (O/E) ratios of fracture by HIV status. Results Accuracy of modified-FRAX was less for HIV-infected (O/E=1.62, 95%CI: 1.45, 1.81) than uninfected men (O/E=1.29, 95%CI: 1.19, 1.40), but improved when HIV was included as a cause of secondary osteoporosis (O/E=1.20, 95%CI: 1.08, 1.34). However, only 3-6% of men with incident fractures were correctly identified by the modified-FRAX using accepted FRAX thresholds for pharmacologic therapy. Conclusions Modified-FRAX underestimated fracture rates more in older HIV-infected than otherwise similar uninfected men. Accuracy improved when HIV was included as a cause of secondary osteoporosis, but it still performed poorly for case-finding. Further studies are necessary to determine how to use FRAX or define an HIV-specific index to risk stratify for screening and treatment in older HIV-infected individuals.

show abstract

“…On the other hand, the positive predictive value was 70%, and in patients with normal BMD, the specificity of FRAX with CRF=83%. Pepe et al also examined the test characteristics of FRAX with CRFs in 50 HIV-infected men with a mean age of 49 and found a sensitivity of 23% and specificity of 100% for detecting men with “bone fragility” (T score<−2.5 or T score between −2.5 and −1.0 plus fracture) when using a FRAX threshold of 7% 25 .…”

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

confidence: 99%

How to predict the risk of fracture in HIV?

Yin

Falutz

2016

Current Opinion in HIV and AIDS

View full text Add to dashboard Cite

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.

show abstract

The combination of FRAX and Ageing Male Symptoms scale better identifies treated HIV males at risk for major fracture

Abstract: Combination of FRAX (without BMD) and AMS improved sensitivity of FRAX alone in identifying HIV patients at fracture risk, at the expense of reduced specificity.

Cited by 34 publications

References 32 publications

Bone mineral density in people living with HIV: a narrative review of the literature

Bone mineral density in people living with HIV: a narrative review of the literature

Fracture Prediction With Modified-FRAX in Older HIV-Infected and Uninfected Men

How to predict the risk of fracture in HIV?

Contact Info

Product

Resources

About