Background/Purpose: The life expectancy of people living with HIV (PLWH) has improved notably since the advent of antiretroviral therapy (ART). However, studies have shown that persons aging with HIV are disproportionately impacted by comorbidities associated with aging, including osteoporosis (OP). The gold standard tool for diagnosing OP is dual-energy X-ray absorptiometry (DXA), however its availability in low-resource settings (LRS) is limited. To address this barrier, low-cost screening tools for OP, such as the Simple Calculated Osteoporosis Risk Estimation (SCORE) and the Osteoporosis Self-Assessment Tool (OST), have been developed. However, these tools have only been validated for the general population, not for PLWH.

Methods: We recruited PLWH (men ≥50 years and postmenopausal women) at three HIV clinics in Lima, Peru. Participants completed a survey regarding OP risk factors, demographics, and clinical characteristics. OP was assessed via DXA. SCORE (based upon age, sex, race, weight, rheumatoid arthritis diagnosis, history of non-traumatic fracture and estrogen use) and OST (based upon age and weight) values were calculated as described in the literature. Since OST does not include sex as a predictor, results were analyzed separately for men and women. Sensitivity (S), specificity (Sp), and predictive values (NPV/PPV) with their 95% confidence intervals were calculated for SCORE and OST using the DXA results as the gold standard.

Results: A total of 166 PLWH were enrolled (89 women, 77 men). The prevalence of OP by DXA was 27.1% (43% for women, 9% for men). For SCORE, at the general population recommended threshold for OP of 6, we found a S=97.8% (88.2%-99.9%), Sp=19.8% (13.1%-28.1%), PPV=31.2% (23.7%-39.5%), and NPV=96% (79.6%-99.9%). For the OST among women, we used the recommended general population threshold of -1, resulting in a S=28.9% (15.4%-45.9%), Sp= 84.3% (71.4%-93%), PPV= 57.9% (33.5%-79.7%), and NPV= 61.4% (49%-72.8%). For the OST among men, the same threshold of -1 yielded a S= 28.6% (3.67%-71%), Sp=97.1% (90.1%-99.7%), PPV= 50% (6.76%-93.2%), and NPV= 93.2% (84.7%-97.7%).

Conclusion: This is the first study validating two screening tools for OP among PLWH. Among our study population, SCORE showed acceptable S and NPV, while OST showed greater Sp. For that reason, in LRS such as Peru, SCORE may represent a better screening tool for identifying patients at high risk for OP who would benefit from further evaluation and management strategies.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/validation-of-the-simple-calculated-osteoporosis-risk-estimation-and-osteoporosis-self-assessment-tool-among-people-aging-with-hiv-in-peru/