Improving Recognition of Fracture Risk in People with Human Immunodeficiency Virus: Performance and Model Contribution of Two Common Risk Assessment Tools

Vizcarra, Pilar; Moreno, Ana; Vivancos, María Jesús; García, Alba; González, Ricardo Pelazas; Gutiérrez, Félix; Mata, Diana Corona; Galindo, Pepa; Calzado, Sònia; Casado, José Luis

doi:10.1089/apc.2022.0183

Cited by 2 publications

(4 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To compare the derived model with the FRAX tool, we calculated FRAX scores using variables collected at the time of CoRIS inclusion as specified in a previous publication. ( 11 ) As the CoRIS database only collects information on medications prescribed chronically, we considered the use of steroids for each record in the database. The use of immunosuppressors (excluding antirejection medication) was considered as a proxy for rheumatoid arthritis or systemic lupus erythematosus diagnosis.…”

Section: Methodsmentioning

confidence: 99%

“…(9,10) However, the FRAX tool has been demonstrated to underestimate the 10-year rate of major osteoporotic fractures in this population, even when discrimination was acceptable. (11,12) Further, it identified less than 10% of incident fragility fractures using the assessment thresholds recommended by current guidelines. (11) Based on these controversies, the aim of this study was to derive and internally validate a prediction tool for fragility fractures in a Spanish national cohort of individuals with HIV and to compare the new model's performance with that of FRAX.…”

Section: Introductionmentioning

confidence: 99%

“…( 9,10 ) However, the FRAX tool has been demonstrated to underestimate the 10‐year rate of major osteoporotic fractures in this population, even when discrimination was acceptable. ( 11,12 ) Further, it identified less than 10% of incident fragility fractures using the assessment thresholds recommended by current guidelines. ( 11 )…”

Section: Introductionmentioning

confidence: 99%

“…( 11,12 ) Further, it identified less than 10% of incident fragility fractures using the assessment thresholds recommended by current guidelines. ( 11 )…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A Risk Assessment Tool for Predicting Fragility Fractures in People with HIV: Derivation and Internal Validation of the FRESIA Model

Vizcarra,

Moreno,

Vivancos

et al. 2023

Journal of Bone and Mineral Research

Self Cite

View full text Add to dashboard Cite

People with HIV have a higher risk of fracture than the general population. Because of the low performance of the existing prediction tools, there is controversy surrounding fracture risk estimation in this population. The aim of the study was to develop a model for predicting the long‐term risk of fragility fractures in people with HIV. We included 11,899 individuals aged ≥ 30 years from the Spanish HIV/AIDS research network cohort. We identified incident fragility fractures from medical records, defined as those non‐traumatic or occurring after a casual fall, at major osteoporotic sites (hip, clinical spine, forearm, proximal humerus). Our model accounted for the competing risk of death and included 12 candidate predictors to estimate the time to first fragility fracture. We assessed the discrimination and calibration of the model and compared it with the FRAX tool. The incidence rate of fragility fractures was 4.34 (95% CI 3.61‐5.22) per 1,000 person‐years. The final prediction model included age, chronic kidney disease, and chronic obstructive pulmonary disease as significant predictors. The model accurately predicted the five‐year and ten‐year risk of fragility fractures, with an area under the receiving operator characteristic curve of 0.768 (95% CI 0.722‐0.814), and agreement between the observed and expected probabilities. Furthermore, it demonstrated better discrimination and calibration than the FRAX tool, improving the classification of over 35% of individuals with fragility fractures compared to FRAX. Our prediction model demonstrated accuracy in predicting the long‐term risk of fragility fractures. It can assist in making personalized intervention decisions for individuals with HIV and may potentially replace the current tools recommended for fracture risk assessment in this population.This article is protected by copyright. All rights reserved.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…( 11,12 ) Further, it identified less than 10% of incident fragility fractures using the assessment thresholds recommended by current guidelines. ( 11 )…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A Risk Assessment Tool for Predicting Fragility Fractures in People with HIV: Derivation and Internal Validation of the FRESIA Model

Vizcarra,

Moreno,

Vivancos

et al. 2023

Journal of Bone and Mineral Research

Self Cite

View full text Add to dashboard Cite

show abstract

Prevalence of HIV-associated osteoporosis and fracture risk in midlife women: a cross-sectional study in Zimbabwe

Madanhire,

Ó Breasail,

Kahari

et al. 2024

Journal of Bone and Mineral Research

View full text Add to dashboard Cite

Antiretroviral therapy roll-out has dramatically reduced HIV-related mortality; more women are living to reach menopause. Menopausal estrogen loss causes bone loss, as does HIV and some of its treatments. However, data describing HIV’s impact on osteoporosis prevalence and fracture risk are scarce in southern Africa. A cross-sectional study of women aged 40-60 years (49% women with HIV [WLH]) was conducted in Harare, Zimbabwe. Menopause, fracture, and HIV history were collected, and anthropometry and BMD (by DXA) measured, and FRAX 10-year fracture probabilities quantified. The FRAX probability of a major osteoporotic fracture (MOF) included HIV as a risk factor for secondary osteoporosis. Linear and Poisson regression determined the relationships between clinical risk factors and both femoral neck (FN) BMD and the 10-year FRAX probability of MOF respectively. The 393 participants had a mean (SD) age of 49.6 (5.8) years and mean (SD) BMI of 29.1 (6.0) kg/m2. 95% of WLH were antiretroviral therapy (ART) established (85% tenofovir disoproxil fumarate) and 81% had a viral load <50 copies/mL. A BMD T-score ≤ –2.5 was more common in WLH than those without, at both FN and lumbar spine (LS) (FN, 22 [11.4%] vs 5 [2.5%]; LS, 40 [20.8%] vs 9 [4.5%], respectively). Prior fracture was more prevalent in WLH: any fracture type (27 [14%] vs 14 [7%]); MOF (14 [7.3%] vs 5 [2.5%]). WLH had a higher 10-year MOF probability (median, 1.2%; IQR, 0.9-1.8) compared with those without HIV (1.0%; IQR, 0.9-1.5) (p < .001), although probabilities were low. Older age, low weight, and HIV infection were strongly associated with lower FN BMD. Higher probability of MOF was associated with older age, HIV infection, parental hip fracture and prior fracture, although adjustment attenuated the association with HIV. No woman reported anti-osteoporosis medication use. While osteoporosis and previous fractures were common and untreated in this relatively young population, particularly in WLH, the FRAX-predicted 10-year MOF risk was low. Clinical risk factors considered in fracture risk prediction tools in Zimbabwe may need contextual modification.

show abstract

Improving Recognition of Fracture Risk in People with Human Immunodeficiency Virus: Performance and Model Contribution of Two Common Risk Assessment Tools

Cited by 2 publications

References 27 publications

A Risk Assessment Tool for Predicting Fragility Fractures in People with HIV: Derivation and Internal Validation of the FRESIA Model

A Risk Assessment Tool for Predicting Fragility Fractures in People with HIV: Derivation and Internal Validation of the FRESIA Model

Prevalence of HIV-associated osteoporosis and fracture risk in midlife women: a cross-sectional study in Zimbabwe

Contact Info

Product

Resources

About