Performance of fracture risk assessment tool in HIV‐positive male individuals aged ≥45 years on suppressive antiretroviral therapy

INTRODUCTION: An age‐specific evaluation and management algorithm for reduced bone mineral density (BMD) is suggested for HIV‐positive patients without major risk factors. Whether combination of BMD and the Fracture Risk Assessment Tool (FRAX) may detect more individuals for therapeutic interventions remains unclear. We aimed to determine the prevalence of middle‐aged or older HIV‐positive males fitting the criteria of therapeutic interventions with different approaches. METHODS: From July 2016 to February 2018, HIV‐positive male patients aged ≥45 years receiving suppressive antiretroviral therapy were recruited in a cross‐sectional study, at two designated hospitals for HIV care in northern Taiwan. Patients with malignancy, AIDS, pre‐existing bone disease or immobilization were excluded. Information on clinical and demographic characteristics, FRAX questionnaire, activity questionnaire, BMD and serum 25(OH)D was obtained. FRAX scores combined with BMD (FRAX/BMD) and without BMD (FRAX) were calculated. The data were analysed on the basis of major risk factors for fragility fracture and age stratification, FRAX score and BMD results respectively. RESULTS: We enrolled 330 patients with a mean age of 51.6 years and CD4 610 cells/μL, in whom 98.1% (n = 324) underwent BMD assessment of one site or more. By FRAX, 6.7% (n = 22) reached treatment thresholds (10‐year risk of major osteoporotic fracture ≥20% and/or hip fracture ≥3%). The prevalence of osteopenia (−2.5 <T‐score <−1) and osteoporosis (T‐score ≤−2.5) was 50.3% and 10.8% respectively. Compared with FRAX, FRAX/BMD identified 17.4% (95% CI 12.0% to 22.8%) more individuals who reached treatment thresholds (24.1% vs. 6.7%); even in the low‐risk group (without major risks for fragility fracture, 45 to 49 years, n = 129), FRAX/BMD identified 12.6% (95% CI 7.9% to 19.7%) more candidates (12.6% vs. 0%). Patients with BMI<22 kg/m(2) (adjusted OR (aOR) 2.86, 95% CI 1.62 to 5.05) and aged ≥50 years (aOR 3.57, 95% CI 1.92 to 6.66) were more likely not to be identified as requiring treatment by FRAX but would be identified as requiring treatment by FRAX/BMD. The sensitivity and specificity of FRAX to detect candidates for interventions was 18.2% (95% CI 10.3% to 28.6%) and 97.9% (95% CI 95.2% to 99.3%) respectively. CONCLUSIONS: With FRAX as a screening approach among HIV‐positive male patients aged ≥45 years, addition of BMD assessment may detect more candidates for therapeutic management.