title: DUAL-ENERGY X-RAY ABSORPTIOMETRY AND CALCULATED FRAX RISK SCORES MAY UNDERESTIMATE OSTEOPOROTIC FRACTURE RISK IN VITAMIN D-DEFICIENT VETERANS WITH HIV INFECTION.
abstract: OBJECTIVE
  We evaluated the utility of the World Health Organization (WHO) Fracture Risk Assessment Tool (FRAX) in assessing fracture risk in patients with human immunodeficiency virus (HIV) and vitamin D deficiency.
  
  
  METHODS
  This was a retrospective study of HIV-infected patients with co-existing vitamin D deficiency at the Atlanta Veterans Affairs Medical Center. Bone mineral density (BMD) was assessed by dual-energy X-ray absorptiometry (DEXA), and the 10-year fracture risk was calculated by the WHO FRAX algorithm. Two independent radiologists reviewed lateral chest radiographs for the presence of subclinical vertebral fractures.
  
  
  RESULTS
  We identified 232 patients with HIV and vitamin D deficiency. Overall, 15.5% of patients met diagnostic criteria for osteoporosis on DEXA, and 58% had low BMD (T-score between -1 and -2.5). The median risk of any major osteoporotic and hip fracture by FRAX score was 1.45 and 0.10%, respectively. Subclinical vertebral fractures were detected in 46.6% of patients. Compared to those without fractures, those with fractures had similar prevalence of osteoporosis (15.3% versus 15.7%; P>.999), low BMD (53.2% versus 59.3%; P = .419), and similar FRAX hip scores (0.10% versus 0.10%; P = .412). While the FRAX major score was lower in the nonfracture group versus fracture group (1.30% versus 1.60%; P = .025), this was not clinically significant.
  
  
  CONCLUSIONS
  We found a high prevalence of subclinical vertebral fractures among vitamin D-deficient HIV patients; however, DEXA and FRAX failed to predict those with fractures. Our results suggest that traditional screening tools for fragility fractures may not be applicable to this high-risk patient population.
authors.forename: Kelly I
authors.initials: KI
authors.lastname: Stephens
authors.forename: Leon
authors.initials: L
authors.lastname: Rubinsztain
authors.forename: John
authors.initials: J
authors.lastname: Payan
authors.forename: Chris
authors.initials: C
authors.lastname: Rentsch
authors.forename: David
authors.initials: D
authors.lastname: Rimland
authors.forename: Vin
authors.initials: V
authors.lastname: Tangpricha
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D003951:Diagnostic Errors; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D012107:Research Design; D012189:Retrospective Studies; D018570:Risk Assessment; D016103:Spinal Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D013223:Statistics as Topic / Q000592:standards; D014728:Veterans / Q000706:statistics & numerical data*; D014808:Vitamin D Deficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*