Fragility fractures (fractures) among persons living with HIV (PWH) account for $99 million in excess costs each year in the United States. Our work has shown a significantly higher annual rate of fractures among PWH in the Veterans Aging Cohort Study (VACS), compared with uninfected individuals (2.0% vs 1.4%). Such fractures are associated with increased rates of hospitalization and nursing home admissions, long-term physical disability, social isolation, and death. Furthermore, these fractures were identified among PWH, the majority of whom were middle-aged (45-64 years). Because middle-age is a time when people are most economically and socially productive, fractures at this time of life set the stage for economic hardship and poorer health outcomes as these individuals grow older. Highly effective methods exist for preventing fractures, rates by 25%-50%. However, there are currently no prediction models that reliably identify PWH at greatest risk for fracture. Accurately identifying these individuals while protecting those at lower risk from the side effects of treatment is an important focus of HIV research and a key concern for OAR (HIV comorbidities) and NIAMS.
The purpose of this project is to develop, validate, and disseminate a Fracture Risk Assessment Calculator that incorporates HIV-relevant risk factors (FRAC-HIV) to calculate the probability of a fracture among persons with HIV (PWH).