Rebecca Slotkin

Fellowship Site: Universidad Peruana Cayetano Heredia

US Institution: Yale University

Project Title: Prevention of Osteoporosis-Related Fractures Among HIV Positive Women in Peru: Assessment of Risk Scores, Knowledge and Health Beliefs

Around the world, osteoporosis-related fractures cause significant morbidity and mortality. Patients with HIV are at increased risk for osteoporosis and fractures due to a combination of traditional risk factors, the nature of chronic infection, and antiretroviral therapy. Dual-energy x-ray absorptiometry (DXA) is the gold-standard technique to assess bone mineral density (BMD), the measure by which osteoporosis is diagnosed. Because it is often not economically or logistically practical to obtain DXA scans for all individuals of a certain age or gender, osteoporosis risk scores have been developed to assist clinical judgement and identify patients at highest risk so they can be referred for DXA screening. In countries like Peru, where DXA machines are not widely available, this targeted approach is particularly important.

In the general population, several osteoporosis risk scores have been validated, however, none of these tools have been studied in HIV positive women in Latin America, and no literature exists on how they can be incorporated into osteoporosis prevention strategies for this population. To optimize the uptake of prevention strategies among women with HIV, understanding patient-oriented factors such as knowledge and health beliefs regarding osteoporosis is critically important.

Approximately 1250 women receive care at the HIV clinic at Loayza Hospital in Lima, Peru. Our proposal will work with a cohort of HIV-positive women over the age of 50 years with previously collected BMD results to measure the performance characteristics (sensitivity, specificity, area under the receiver operating characteristic curve) of four validated osteoporosis risk scores (Osteorisk, SCORE, ORAI, OST). Patients returning for routine follow up to the HIV clinic will complete the osteoporosis knowledge test and osteoporosis health beliefs score. These surveys are theory-driven, validated tools for assessment of osteoporosis-related knowledge and health beliefs that have been used successfully among community-dwelling Peruvian women. The ultimate goal of our project is to provide valuable insight into how screening and prevention of osteoporosis may be optimized, within the resource practicalities of countries like Peru, for an HIV positive population.