The combination of FRAX and Ageing Male Symptoms scale better identifies treated HIV males at risk for major fracture.
OBJECTIVE
Osteoporosis and hypogonadism are common in men with HIV infection. Ageing Male Symptoms (AMS) scale measures symptoms related to hypogonadism. FRAX provides 10-year probability of major fractures. We investigated the role of AMS scale combined with FRAX without bone mineral density (BMD), in identifying HIV men with bone fragility.


METHODS
Cross-sectional observational study.


METHODS
Fifty HIV-positive men treated with highly active antiretroviral therapy and 27 controls underwent hormonal evaluation, BMD scan and spine X-ray. The AMS questionnaire was administered.


RESULTS
Osteoporosis was found in 24·0% of HIV patients and in 3·7% of controls (P = 0·05). In HIV patients, 9 radiological vertebral fractures were found (none in controls, P = 0·04). Calculated free testosterone suggested hypogonadism in 26% of HIV patients vs 4% of controls (P = 0·04); an abnormal AMS score (≥27) was found in 62% HIV patients compared with 41% controls (P = 0·04). ROC curves showed that FRAX for major fracture had a 23% sensitivity and a 100% specificity in identifying HIV patients with bone fragility (P = 0·002, with the threshold of 7% at which bisphosphonate therapy is cost-effective). Considering a value of AMS ≥27, we obtained an 82·6% sensitivity and a 42·9% specificity (P = 0·04). The combination of AMS and FRAX score achieved a 77·3% sensitivity and a 69% specificity (P = 0·02, cut-off 34).


CONCLUSIONS
Combination of FRAX (without BMD) and AMS improved sensitivity of FRAX alone in identifying HIV patients at fracture risk, at the expense of reduced specificity.
Department of Internal Medicine and Medical Disciplines, Sapienza University, Rome, Italy. jesspepe@tin.it
Jessica
J
Pepe
Andrea M
AM
Isidori
Mario
M
Falciano
Giancarlo
G
Iaiani
Alessandra
A
Salotti
Daniele
D
Diacinti
Romano
R
Del Fiacco
Emilia
E
Sbardella
Cristiana
C
Cipriani
Sara
S
Piemonte
Elisabetta
E
Romagnoli
Andrea
A
Lenzi
Salvatore
S
Minisola
D000328:Adult; D000368:Aged; D000465:Algorithms; D023241:Antiretroviral Therapy, Highly Active; D015519:Bone Density / Q000502:physiology; D003430:Cross-Sectional Studies; D050723:Fractures, Bone / Q000517:prevention & control*; D015658:HIV Infections / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis*; D011795:Surveys and Questionnaires