FRAX assessment in people ageing with HIV.
FRAX
HIV
PLWH
fracture risk
osteoporosis
Journal
HIV medicine
ISSN: 1468-1293
Titre abrégé: HIV Med
Pays: England
ID NLM: 100897392
Informations de publication
Date de publication:
01 2022
01 2022
Historique:
received:
06
07
2021
accepted:
13
08
2021
pubmed:
21
9
2021
medline:
15
3
2022
entrez:
20
9
2021
Statut:
ppublish
Résumé
Current British HIV Association (BHIVA) guidelines recommend the use of FRAX for the routine assessment of bone fracture risk in people living with HIV over 50 years of age every 3 years. Bone mineral density measurement with dual-energy X-ray absorptiometry (DXA) scan is recommended for those with increased fracture risk (FRAX major > 10%). Our objectives were to estimate the prevalence of and risk factors for osteoporosis in a population of PLWH aged > 50 years and assess the utility of FRAX in predicting the presence of DXA-proven osteoporosis in this cohort. This was a cross-sectional study of a cohort of PLWH aged > 50 years attending the Chelsea and Westminster Hospital and who had a DXA scan between January 2009 and December 2018. FRAX scores were calculated using the Sheffield algorithm. Multiple regression models and Cohen's kappa values were used to assess risk factors for osteoporosis and agreement between FRAX and DXA scan results, respectively. In all, 744 patients were included (92.9% male, mean age 56 ± 5 years). The prevalence rates of osteoporosis (at DXA scans) and osteopenia were 12.2% and 63.7%, respectively. FRAX major was > 10% in only two patients, while 90/91 (98.9%) patients with osteoporosis had a normal FRAX score. The presence of osteoporosis was significantly associated with low body mass index and estimated glomerular filtration rate (p < 0.05). Our results indicate that FRAX scores did not predict the presence of osteoporosis in our population of PLWH over 50 years of age and therefore FRAX scores may not be the appropriate tool to define eligibility to perform DXA scans in PLWH.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
103-108Informations de copyright
© 2021 British HIV Association.
Références
Mallon PWG. HIV and bone mineral density. Curr Opin Infect Dis. 2010;23:1-8.
Battalora L, Buchacz K, Armon C, et al. Low bone mineral density and risk of incident fracture in HIV-infected adults. Antivir Ther. 2016;21:45-54.
Dempster DW. Osteoporosis and the burden of osteoporosis-related fractures. Am J Manag Care. 2011;17:164-169.
Reddy KP, Kong CY, Hyle EP, et al. Lung cancer mortality associated with smoking and smoking cessation among people living with HIV in the United States. JAMA Intern Med. 2017;177:1613-1621.
Hahn JA, Samet JH. Alcohol and HIV disease progression: weighing the evidence. Curr HIV/AIDS Rep. 2010;7:226-233.
Dao CN, Patel P, Overton ET, et al. Low vitamin D among HIV-infected adults: prevalence and risk factors for low vitamin D levels in a cohort of HIV-infected adults and comparison to prevalence among adults in the US general population. Clin Infect Dis. 2011;52:405.
Ofotokun I, McIntosh E, Weitzmann MN. HIV: inflammation and bone. Curr HIV/AIDS Rep. 2012;9:16-25.
Titanji K, Vunnava A, Sheth AN, et al. Dysregulated cell expression of RANKL and OPG correlated with loss of bone mineral density in HIV infection. PLoS Pathog. 2014;10:e1004497.
Kinai E, Nishijima T, Mizushima D, et al. Long-term use of protease inhibitors is associated with bone mineral density loss. AIDS Res Hum Retroviruses. 2014;30:553-559.
Stellbring HJ, Orkin C, Arribas JR, et al. Comparison of changes in bone density and turnover with abacavir/lamivudine versus tenofovir/emtricitabine in HIV-infected adults: 48-week results from the ASSERT study. Clin Infect Dis. 2010;51:963-972.
Angus B, Brook G, Awosusi F, et al. BHIVA guidelines for the routine investigation and monitoring of adult HIV-1 positive individuals (2019 interim update). BHIVA. 2019. Accessed December 4, 2019. https://www.bhiva.org/monitoring-guidelines
Ryom L, Cotter A, De Miguel R, et al. 2019 update of the European AIDS clinical society guidelines for the treatment of people living with HIV version 10.0. HIV Med. 2020;21:617-624.
Sl S, Calderon AD. The utility and limitations of FRAX: a US perspective. Curr Osteoporos Rep. 2010;8:192-197.
Waters L, Patterson B, Scourfield A, et al. A dedicated clinic for HIV-positive individuals over 50 years of age: a multidisciplinary experience. Int J STDs AIDS. 2012;23:546-552.
FRAX® calculator. Accessed May 15, 2021. https://www.sheffield.ac.uk/FRAX/index.aspx?lang=it
Compston JE, Drake MT. Defining very high fracture risk: is FRAX fit for purpose? J Bone Min Res. 2020;35:1399-1403.
WHO Scientific Group on the Prevention and Management of Osteoporosis. Prevention and management of osteoporosis: report of a WHO scientific group. 2000; 7:31.17.
Nuti R, Brandi ML, Checchia G, et al. Guidelines for the management of osteoporosis and fragility fractures. Intern Emerg Med. 2019;14:85-102.
Brown TT, Qaqish RB. Antiretroviral therapy and the prevalence of osteopenia and osteoporosis: a meta-analytic review. AIDS. 2006;20:2165-2174.
Pramukti I, Lindavani L, Chen YC, et al. Bone fracture among people living with HIV: a systematic review and meta-regression of prevalence, incidence, and risk factors. PLoS One. 2020;15:e0233501.
Mazzotta E, Ursini T, Agostinone A, et al. Prevalence and fractures among HIV-infected patients at one Italian center after universal DXA screening: sensitivity and specific of current guidelines on bone mineral density management. AIDS pat care STDs. 2015;29:169-180.
McComsey GA, Tebas P, Shane E, et al. Bone disease in HIV infection: a practical review and recommendations for HIV care providers. Clin Infec Dis. 2010;8:937-946.
Johansson H, Kanis JA, Oden A, et al. Impact of femoral neck and lumbar spine BMD discordances on FRAX probabilities in women; a meta-analysis of international cohorts. Calcif Tissue Int. 2015;95:428-435.
Leslie WD, Lix LM. Absolude fracture risk assessment using lumber spine and femoral neck bone density measurements: derivation and validation of a hybrid system. J Bone Miner Res. 2011;3:460-467.