Performance of a Modified Fracture Risk Assessment Tool for Fragility Fracture Prediction Among Older Veterans Living With HIV

Authors

Julie A Womack
Terrence E Murphy
Linda Leo-Summers
Farah Kidwai-Khan
Melissa Skanderson
Thomas M Gill
Barbara Gulanski
Maria C Rodriguez-Barradas
Phyllis C Tien
Michael T Yin
Evelyn Hsieh

Publication Date

7-15-2023

Journal

AIDS

DOI

10.1097/QAD.0000000000003566

PMID

37070536

PMCID

PMC10329997

PubMedCentral® Posted Date

7-15-2024

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Humans, Osteoporotic Fractures, Cohort Studies, Risk Factors, Veterans, Bone Density, Risk Assessment, HIV Infections, Hip Fractures, fragility fractures, FRAX, HIV, discrimination, calibration, predictive model

Abstract

OBJECTIVE: Fragility fractures (fractures) are a critical outcome for persons aging with HIV (PAH). Research suggests that the fracture risk assessment tool (FRAX) only modestly estimates fracture risk among PAH. We provide an updated evaluation of how well a 'modified FRAX' identifies PAH at risk for fractures in a contemporary HIV cohort.

DESIGN: Cohort study.

METHODS: We used data from the Veterans Aging Cohort Study to evaluate veterans living with HIV, aged 50+ years, for the occurrence of fractures from 1 January 2010 through 31 December 2019. Data from 2009 were used to evaluate the eight FRAX predictors available to us: age, sex, BMI, history of previous fracture, glucocorticoid use, rheumatoid arthritis, alcohol use, and smoking status. These predictor values were then used to estimate participant risk for each of two types of fractures (major osteoporotic and hip) over the subsequent 10 years in strata defined by race/ethnicity using multivariable logistic regression.

RESULTS: Discrimination for major osteoporotic fracture was modest [Blacks: area under the curve (AUC) 0.62; 95% confidence interval (CI) 0.62, 0.63; Whites: AUC 0.61; 95% CI 0.60, 0.61; Hispanic: AUC 0.63; 95% CI 0.62, 0.65]. For hip fractures, discrimination was modest to good (Blacks: AUC 0.70; 95% CI 0.69, 0.71; Whites: AUC 0.68; 95% CI 0.67, 0.69]. Calibration was good in all models across all racial/ethnic groups.

CONCLUSION: Our 'modified FRAX' exhibited modest discrimination for predicting major osteoporotic fracture and slightly better discrimination for hip fracture. Future studies should explore whether augmentation of this subset of FRAX predictors results in enhanced prediction of fractures among PAH.

Comments

Associated Data