OBJECTIVE: Osteoporosis and hypogonadism are common in men with HIV infection. 
Ageing Male Symptoms (AMS) scale measures symptoms related to hypogonadism. FRAX 
provides 10-year probability of major fractures. We investigated the role of AMS 
scale combined with FRAX without bone mineral density (BMD), in identifying HIV 
men with bone fragility.
DESIGN: Cross-sectional observational study.
METHODS: Fifty HIV-positive men treated with highly active antiretroviral 
therapy and 27 controls underwent hormonal evaluation, BMD scan and spine X-ray. 
The AMS questionnaire was administered.
RESULTS: Osteoporosis was found in 24·0% of HIV patients and in 3·7% of controls 
(P = 0·05). In HIV patients, 9 radiological vertebral fractures were found (none 
in controls, P = 0·04). Calculated free testosterone suggested hypogonadism in 
26% of HIV patients vs 4% of controls (P = 0·04); an abnormal AMS score (≥27) 
was found in 62% HIV patients compared with 41% controls (P = 0·04). ROC curves 
showed that FRAX for major fracture had a 23% sensitivity and a 100% specificity 
in identifying HIV patients with bone fragility (P = 0·002, with the threshold 
of 7% at which bisphosphonate therapy is cost-effective). Considering a value of 
AMS ≥27, we obtained an 82·6% sensitivity and a 42·9% specificity (P = 0·04). 
The combination of AMS and FRAX score achieved a 77·3% sensitivity and a 69% 
specificity (P = 0·02, cut-off 34).
CONCLUSION: Combination of FRAX (without BMD) and AMS improved sensitivity of 
FRAX alone in identifying HIV patients at fracture risk, at the expense of 
reduced specificity.