A risk assessment tool for predicting fragility fractures in people with HIV: derivation and internal validation of the FRESIA model.

People with HIV have a higher risk of fracture than the general population. Because of the low performance of the existing prediction tools, there is controversy surrounding fracture risk estimation in this population. The aim of the study was to develop a model for predicting the long-term risk of fragility fractures in people with HIV. We included 11,899 individuals aged ≥ 30 years from the Spanish HIV/AIDS research network cohort. We identified incident fragility fractures from medical records, defined as those non-traumatic or occurring after a casual fall, at major osteoporotic sites (hip, clinical spine, forearm, proximal humerus). Our model accounted for the competing risk of death and included 12 candidate predictors to estimate the time to first fragility fracture. We assessed the discrimination and calibration of the model and compared it with the FRAX tool. The incidence rate of fragility fractures was 4.34 (95% CI 3.61-5.22) per 1,000 person-years. The final prediction model included age, chronic kidney disease, and chronic obstructive pulmonary disease as significant predictors. The model accurately predicted the five-year and ten-year risk of fragility fractures, with an area under the receiving operator characteristic curve of 0.768 (95% CI 0.722-0.814), and agreement between the observed and expected probabilities. Furthermore, it demonstrated better discrimination and calibration than the FRAX tool, improving the classification of over 35% of individuals with fragility fractures compared to FRAX. Our prediction model demonstrated accuracy in predicting the long-term risk of fragility fractures. It can assist in making personalized intervention decisions for individuals with HIV and may potentially replace the current tools recommended for fracture risk assessment in this population. This article is protected by copyright. All rights reserved.