Prediction of Osteoporosis Risk in People Living With HIV: A Nomogram for Early Identification.

BACKGROUND

People living with HIV (PLWH) are at increased risk of osteoporosis because of chronic inflammation, immune dysregulation, and long-term antiretroviral therapy (ART). This study aimed to develop and internally validate a predictive model for osteoporosis risk tailored to PLWH.

SETTING

This retrospective study was conducted at the HIV outpatient department of Yuyao People's Hospital between January 2022 and December 2023, and included PLWH. Osteoporosis was diagnosed using dual-energy X-ray absorptiometry according to standard criteria.

METHODS

Clinical and laboratory data were collected. A nomogram was constructed based on multivariate logistic regression, including variables with univariate P < 0.1. Model performance was assessed using receiver operating characteristic curve analysis area under the curve (AUC), calibration curves, and decision curve analysis (DCA).

RESULTS

Of the 467 PLWH, 139 (29.8%) had osteoporosis or low bone mass. The final model included sex, age, duration of ART, CD4 count, CD8 count, white blood cell count, platelet count, hemoglobin, total cholesterol, and ALT as predictors. The nomogram demonstrated strong discriminative performance (AUC = 0.865, 95% CI: 0.826 to 0.897), good calibration (mean absolute error = 0.027), and favorable clinical utility by DCA.

CONCLUSIONS

This internally validated model provides good predictive accuracy for osteoporosis risk among PLWH and may assist clinicians in early identification and targeted intervention.