Available online 7 December 2023, 101460

Author links open overlay panel, , , , , , AbstractBackground

Aging of the HIV-infected population and prolonged use of ARTs, produced metabolic alterations, including increased fracture risk. FRAX is a validated, computer-based clinical fracture risk calculator which estimates 10-year risk of major fracture, and hip fracture. However may underestimate risk in HIV-infected individuals. Several experts recommend considering HIV a cause of secondary osteoporosis.

Methodology

Were included 52 men living with HIV, classified as high, moderate and low risk using ABRASSO graphic tool.

Results

High risk prevalence found for major fracture and hip fracture were both 2 (4.2%) using FRAX; while 10 (20.8%) and 14 (29.2%) using modified FRAX, respectively. Considering bone densitometry, 5 (12.8%) were high risk for hip fracture and was noticed an increase in high risk major fracture from 4.2% from FRAX to 5.1% with FRAX considering bone densitometry. As for the low risk, 19 (39.6%) for major fracture and 23 (47.9%) for hip fracture with FRAX. While low risk modified FRAX were 0 (0%) for major fracture and 8 (16.7%) for hip fracture. It was also evidenced an association of high risk for major fracture and hip fracture with modified FRAX using Fisher's exact test [p=0.0273 (bilateral)].

Conclusion

It was concluded is recommended using modified FRAX for people living with HIV for better control and therapeutic decision-making about osteometabolic alterations provocated for the virus and ARTs.

Section snippetsBackground

Reduced bone mineral density (BMD) is observed in people living with HIV/AIDS (PLWHA), and consequently osteopenia and osteoporosis with an elevated prevalence of fractures compared to the general population1. Since the discovery of HIV-1, more than 40 antiretroviral drugs have been developed, which are able to control the infection when used in various combinations, their use is recommended regardless of CD4 count and has been followed by an increase in life expectancy of PLWHA2. However, the

Methods

This study is a quantitative, cross-sectional analysis, with an analytical-exploratory observational approach, being classified in terms of purpose as applied research. The study was conducted in the city of Belém, state of Pará, Brazil, the participants consisted of male patients living with HIV/AIDS treated at an endocrinology clinic. An interview was carried out to collect data from the patient, their risk factors, and bone densitometry. FRAX and modified FRAX (considering HIV infection as a

Results

In this study were analyzed data from 52 male patients living with HIV/AIDS, which were classified as high, moderate and low risk by FRAX, modified FRAX, and FRAX with BMD, the values obtained were shown in Table 01. It was not possible to calculate the risk of 3 patients in the FRAX and 12 in the FRAX with BMD, as 3 were aged below 40 years, and 9 did not have results from BMD.

High risk prevalence for major fracture and hip fracture was 2 (4.2%) in FRAX, but in modified FRAX values found were

Discussion

Our study evaluated the risk of fractures in males living with HIV/AIDS using FRAX and modified FRAX. PLWHA have reduced BMD and, therefore, have increased risk for fractures1,10-11. Our results suggest a risk of fracture underestimated by FRAX in this population. For that reason, it's possible that patients who need treatment are not receiving the attention needed.

Previous research identified greater accuracy of FRAX when adding HIV as a risk factor for secondary osteoporosis12. Yin et al

Conclusions

Although the use of ART has changed the course of the natural history of disease and increased life expectancy of PLWHA, metabolic alterations caused by its use and by the virus itself were observed, with the risk of fragility fracture being 35% higher in this population9. For this reason, it's necessary to further investigate the effects on BMD, adopt measures for better categorization of high-risk patients and employ preventive actions.

It is supported by the current literature that the FRAX

Declaration of Competing Interest

None.

Acknowledgments

None.

Funding source

No funding.

Financial Disclosure

The authors have no financial relationships relevant to this article

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© 2023 The International Society for Clinical Densitometry. Published by Elsevier Inc.