Fracture prediction with modified-FRAX in older HIV-infected and uninfected men

Michael T. Yin, Stephanie Shiau, David Rimland, Cynthia L. Gibert, Roger J. Bedimo, Maria C. Rodriguez-Barradas, Katherine Harwood, Josh Aschheim, Amy C. Justice, Julie A. Womack

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalJournal of acquired immune deficiency syndromes (1999)
DOIs
StateAccepted/In press - Mar 19 2016

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HIV
Osteoporosis
Hip Fractures
Shoulder Fractures
Veterans
Forearm
Bone Density
Hip
Decision Making
Spine
Cohort Studies
Therapeutics

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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Fracture prediction with modified-FRAX in older HIV-infected and uninfected men. / Yin, Michael T.; Shiau, Stephanie; Rimland, David; Gibert, Cynthia L.; Bedimo, Roger J.; Rodriguez-Barradas, Maria C.; Harwood, Katherine; Aschheim, Josh; Justice, Amy C.; Womack, Julie A.

In: Journal of acquired immune deficiency syndromes (1999), 19.03.2016.

Research output: Contribution to journalArticle

Yin, MT, Shiau, S, Rimland, D, Gibert, CL, Bedimo, RJ, Rodriguez-Barradas, MC, Harwood, K, Aschheim, J, Justice, AC & Womack, JA 2016, 'Fracture prediction with modified-FRAX in older HIV-infected and uninfected men', Journal of acquired immune deficiency syndromes (1999). https://doi.org/10.1097/QAI.0000000000000998
Yin, Michael T. ; Shiau, Stephanie ; Rimland, David ; Gibert, Cynthia L. ; Bedimo, Roger J. ; Rodriguez-Barradas, Maria C. ; Harwood, Katherine ; Aschheim, Josh ; Justice, Amy C. ; Womack, Julie A. / Fracture prediction with modified-FRAX in older HIV-infected and uninfected men. In: Journal of acquired immune deficiency syndromes (1999). 2016.
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abstract = "BACKGROUND:: FRAX{\circledR} 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.",
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T1 - Fracture prediction with modified-FRAX in older HIV-infected and uninfected men

AU - Yin, Michael T.

AU - Shiau, Stephanie

AU - Rimland, David

AU - Gibert, Cynthia L.

AU - Bedimo, Roger J.

AU - Rodriguez-Barradas, Maria C.

AU - Harwood, Katherine

AU - Aschheim, Josh

AU - Justice, Amy C.

AU - Womack, Julie A.

PY - 2016/3/19

Y1 - 2016/3/19

N2 - 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.

AB - 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.

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