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Comparison of peripheral forearm DXA and clinical risk factor screening using FRAX(R) to assess the risk of HIV-associated low bone mass: a cross-sectional study

Comparison of peripheral forearm DXA and clinical risk factor screening using FRAX(R) to assess the risk of HIV-associated low bone mass: a cross-sectional study
Comparison of peripheral forearm DXA and clinical risk factor screening using FRAX(R) to assess the risk of HIV-associated low bone mass: a cross-sectional study
Summary

There is growing awareness that HIV infection is associated with low bone mass and fracture. DXA is a relatively scarce resource. Therefore, we evaluated two tools: peripheral DXA (pDXA) at the forearm and Fracture Risk Assessment Tool (FRAX®) to see which performed best at identifying men who should undergo DXA. In this setting, neither pDXA nor FRAX® showed good sensitivity and specificity for DXA.

Purpose

Infection with human immunodeficiency virus (HIV) is associated with an increased risk of low bone mineral density (BMD) and fractures. European guidance advocates screening using the FRAX® tool at diagnosis, on initiation of antiretroviral therapy and biannually thereafter in order to decide the need for DXA scanning. This cross-sectional study evaluates the performance of FRAX® and compares its sensitivity and specificity with that of another screening tool, peripheral forearm DXA (pDXA).

Methods

HIV-infected men with varying exposure to antiretroviral therapies were recruited. FRAX® scores were calculated for all participants and everybody underwent pDXA scanning. Femoral neck and lumbar spine BMD was acquired on a Hologic QDR machine by an assessor blinded to the results of the FRAX® and pDXA.

Results

One hundred and sixty-eight men (median age 45 years) were recruited with a median duration since HIV diagnosis of 74 months. In total, 21 % of subjects had either osteoporosis (aged ?50 years) or BMD lower than expected for age (aged <50 years), according to axial DXA. Using a pDXA screening threshold of T????0.9, sensitivity was high (91 %) in defining those with the worst BMD on axial DXA but with poorer specificity (33 %). Alternately, using a threshold of T????2.7 reduced sensitivity (34 %) with an increase in specificity (91 %). FRAX® with HIV included as a secondary risk factor had poor sensitivity (31 %) and specificity (74 %) for detecting those with the poorest BMD on axial DXA.

Conclusion

In this setting, neither pDXA scanning nor FRAX® was sensitive and specific for low bone mass on DXA and neither was performance much improved by using both screening tools. Prospective studies with fracture as an outcome are required in HIV.
HIV, antiretroviraltherapies, FRAX®, pDXA, DXA, screening
1862-3522
1-6
Short, C.E.
77d5b9f4-a00c-4cf8-af10-f6aa94ad09d6
Shaw, S.G.
bb6cabf3-de08-4509-8081-3065ccdb21c5
Fisher, M.J.
9662c037-03c2-4a45-9b58-9b83fe5b323d
Gilleece, Y.C.
ac5500ff-16e5-4091-bbbb-6c5fdf844828
Walker-Bone, K.
ad7d1336-ed2c-4f39-ade5-da84eb412109
Short, C.E.
77d5b9f4-a00c-4cf8-af10-f6aa94ad09d6
Shaw, S.G.
bb6cabf3-de08-4509-8081-3065ccdb21c5
Fisher, M.J.
9662c037-03c2-4a45-9b58-9b83fe5b323d
Gilleece, Y.C.
ac5500ff-16e5-4091-bbbb-6c5fdf844828
Walker-Bone, K.
ad7d1336-ed2c-4f39-ade5-da84eb412109

Short, C.E., Shaw, S.G., Fisher, M.J., Gilleece, Y.C. and Walker-Bone, K. (2014) Comparison of peripheral forearm DXA and clinical risk factor screening using FRAX(R) to assess the risk of HIV-associated low bone mass: a cross-sectional study. Archives of Osteoporosis, 9 (181), 1-6. (doi:10.1007/s11657-014-0181-4). (PMID:24847675)

Record type: Article

Abstract

Summary

There is growing awareness that HIV infection is associated with low bone mass and fracture. DXA is a relatively scarce resource. Therefore, we evaluated two tools: peripheral DXA (pDXA) at the forearm and Fracture Risk Assessment Tool (FRAX®) to see which performed best at identifying men who should undergo DXA. In this setting, neither pDXA nor FRAX® showed good sensitivity and specificity for DXA.

Purpose

Infection with human immunodeficiency virus (HIV) is associated with an increased risk of low bone mineral density (BMD) and fractures. European guidance advocates screening using the FRAX® tool at diagnosis, on initiation of antiretroviral therapy and biannually thereafter in order to decide the need for DXA scanning. This cross-sectional study evaluates the performance of FRAX® and compares its sensitivity and specificity with that of another screening tool, peripheral forearm DXA (pDXA).

Methods

HIV-infected men with varying exposure to antiretroviral therapies were recruited. FRAX® scores were calculated for all participants and everybody underwent pDXA scanning. Femoral neck and lumbar spine BMD was acquired on a Hologic QDR machine by an assessor blinded to the results of the FRAX® and pDXA.

Results

One hundred and sixty-eight men (median age 45 years) were recruited with a median duration since HIV diagnosis of 74 months. In total, 21 % of subjects had either osteoporosis (aged ?50 years) or BMD lower than expected for age (aged <50 years), according to axial DXA. Using a pDXA screening threshold of T????0.9, sensitivity was high (91 %) in defining those with the worst BMD on axial DXA but with poorer specificity (33 %). Alternately, using a threshold of T????2.7 reduced sensitivity (34 %) with an increase in specificity (91 %). FRAX® with HIV included as a secondary risk factor had poor sensitivity (31 %) and specificity (74 %) for detecting those with the poorest BMD on axial DXA.

Conclusion

In this setting, neither pDXA scanning nor FRAX® was sensitive and specific for low bone mass on DXA and neither was performance much improved by using both screening tools. Prospective studies with fracture as an outcome are required in HIV.

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More information

e-pub ahead of print date: 14 May 2014
Keywords: HIV, antiretroviraltherapies, FRAX®, pDXA, DXA, screening
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 366372
URI: http://eprints.soton.ac.uk/id/eprint/366372
ISSN: 1862-3522
PURE UUID: f5d7e8f1-26d0-4be9-9907-b97dca711e71
ORCID for K. Walker-Bone: ORCID iD orcid.org/0000-0002-5992-1459

Catalogue record

Date deposited: 25 Jun 2014 14:39
Last modified: 10 Dec 2019 01:49

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Contributors

Author: C.E. Short
Author: S.G. Shaw
Author: M.J. Fisher
Author: Y.C. Gilleece
Author: K. Walker-Bone ORCID iD

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