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. Design 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 similar to=similar to 0.05). In HIV patients, 9 radiological vertebral fractures were found (none in controls, P similar to=similar to 0.04). Calculated free testosterone suggested hypogonadism in 26% of HIV patients vs 4% of controls (P similar to=similar to 0.04); an abnormal AMS score (=27) was found in 62% HIV patients compared with 41% controls (P similar to=similar to 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 similar to=similar to 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 similar to=similar to 0.04). The combination of AMS and FRAX score achieved a 77.3% sensitivity and a 69% specificity (P similar to=similar to 0.02, cut-off 34). Conclusion 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.