320. UK-HOPS (HIV Osteoporosis Prevention and Screening)-Gaps in the Care of HIV Patients with Bone Disease

Abstract

Background With increasing life expectancy among people living with Human Immunodeficiency Virus (HIV), long-term complications such as osteoporosis/osteopenia and fractures are frequently seen. Although screening guidelines exist for bone disease in the HIV population, quantitative and qualitative gaps exist in screening and prevention. Bone disease in HIV is multifactorial, and FRAX may not accurately predict fracture risk. The aim of our study is to describe diagnostic features of bone disease and estimate the population at risk, and evaluate the frequency of screening, referral and treatment in patients attending an HIV Clinic. Methods We performed a retrospective analysis of 1220 patients with HIV infection ≥40 years of age who attended the HIV clinic under the Ryan White program, during January 2016 to December 2018, at University of Kentucky. We obtained demographic details (Table 1), comorbidities, laboratory testing, bone mineral density (BMD) testing and specialty bone clinic referral data from electronic health records, applying ICD -10 and CPT codes. We estimated the frequency of BMD measurement and prevalence of risk factors for bone disease specific to this population. Results BMD testing was performed in only 158 (13%) patients (CMS targets 60% for testing at-risk populations). Of these patients, 76 (48%) had osteopenia and 59 (37%) had osteoporosis; 22 (14%) received treatment (Figure 1). Seven patients with osteoporosis/osteopenia and fracture had bone biopsy, with low bone turnover in four (57%). Potential risk factors for secondary osteoporosis are presented in Table 2; at least one factor was present in 98% of patients. Fracture prevalence was likely underestimated because the ICD-10 /CPT coding was available only in 23 (2%) patients. Conclusion Bone disease is under-recognized and undertreated, and targeted screening programs are needed for earlier diagnosis and management in this population. Bisphosphonates may not be optimal first-line therapy for all HIV patients with bone loss. In addition to stress or fragility fractures and worsening osteoporosis, metabolic bone work-up should be performed in patients with secondary osteoporosis related to CKD, renal phosphate loss, prior bisphosphonate/Tenofovir/glucocorticoid treatment. Disclosures All authors: No reported disclosures.