Background
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. The gold standard tool for diagnosing osteoporosis is dual-energy X-ray absorptiometry (DXA), however its availability in low-resource settings is limited. To address this barrier, low-cost screening tools for osteoporosis, 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 between March 2022 to August 2023. Participants completed a survey regarding osteoporosis risk factors, demographics, and clinical characteristics. Osteoporosis 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), mean age 56.9±6.3. The prevalence of osteoporosis by DXA was 27.1% (43% for women, 9% for men). For SCORE, at the general population recommended threshold 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%).
Conclusions
This is the first study validating two screening tools for osteoporosis among PLWH.SCORE showed acceptable S and NPV, while OST showed greater Sp. Consequently, in low-resource settings such as Peru, SCORE may be more suitable for identifying high-risk patients for further evaluation and management of osteoporosis.