Background The Fracture Risk Assessment Tool (FRAX) is a validated clinical fracture risk calculator that estimates 10-year risk of both major osteoporotic and hip fractures in the general population. However, its role in patients with human immunodeficiency virus (HIV) infection is still not clear because may underestimate their risk.
Objectives To assess the bone mineral density (BMD) and 10-year fracture risk according to FRAX in HIV-infected patients followed in a tertiary hospital of Madrid and compare them with the ESOSVAL cohort, which included 11035 patients and is representative of the non-HIV population seen in Spanish tertiary hospitals.
Methods We performed a cross-sectional study in which FRAX and BMD values were determined in a prospective cohort that included HIV-infected patients seen our center during the period from 2010 to 2015. Collected data included demography, comorbidities, treatment, risk factors required for the FRAX calculation and densitometric variables.
Results 97 patients from a total of a total of 311 had bone densitometry data and FRAX assessment available and were included in this study. The mean age of the patients was 55.4 years (range: 50–80), 75 were men (77%), most of them were Caucasians (89%), with a mean body mass index of 24.2 (range: 15–32.7). Median time of HIV infection was 194 months (interquartile range [IQR]: 155.2- 259), median nadir of CD4+ cells was 168 (IQR: 81–308) and concomitant hepatitis C virus infection was present in 40%. Among the risk factors included in FRAX calculation, 44% reported smoking, 10% inadequate alcohol consumption and 3% hyperthyroidism; there was no history of steroid therapy or previous fractures and only one had a family history of hip fracture. The mean value of BMD in lumbar spine (LS) was 0.9 g/cm2 (range: 0.83–0.99) and in femoral neck (FN) 0.74 g/cm2 (range: 0.65–0.82). For the comparison with the ESOSVAL cohort the worst value of T-score in either LS or FN was chosen and the patients were classified according to WHO definitions; the results are presented in the table. Only the data for the 50–64 years group were compared because the number of older HIV patients in our center was small. No significant differences were found between the categories of osteopenia and osteoporosis in both genders, but there was a significant difference with respect to the risk of both major and hip fractures in males, being higher in patients with HIV infection compared to the population of the ESOSVAL cohort.
Conclusions HIV-infected patients followed in our center do not show significant differences regarding the prevalence of osteopenia and osteoporosis compared to non-HIV Spanish population represented by the ESOSVAL cohort. However, a trend towards a lesser BMD is seen in all HIV infected groups. The fracture risk estimated by FRAX is significantly higher in HIV-infected men probably due to a higher frequency of associated risk factors.
Disclosure of Interest None declared