HIV Found at Risk of Increased Fractures

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HIV patients have been found to be at higher risk of bone fractures than the general population, according to a new study reported online in Clinical Infectious Diseases.

Benjamin Young, MD, PhD, of the Rocky Mountain Center for AIDS Research, Education, and Services in Denver, and colleagues analyzed data from HIV Outpatient Study (HOPS)patients (n = 5,826) with at least two clinical encounters during the period from 1 January 2000 through 31 December 2008 using HOPS data updated as of 13 March 2009.

The HIV Outpatient Study (HOPS) is an open, prospective observational cohort study of HIV-infected adults followed at 10 specialty clinics in 8 US cities.

Low bone mineral density (BMD) is common among persons with human immunodeficiency virus (HIV) infection. A recent meta-analysis estimated that 67% of HIV-infected persons exhibited reduced BMD, and 15% had osteoporosis, but there is limited data on the incidence of fractures.

Young and colleagues assessed rates of first fractures at any anatomic site during the period 2000–2008. The rates of fracture in the HOPS patients were indirectly standardized to the general population by age and sex, using data from outpatients in the National Hospital Ambulatory Medical Care Survey (NHAMCS-OPD). They examined factors associated with fractures using Cox proportional hazards modeling.

Of the 5826 active HOPS patients whose data were analyzed, 79% were male, 52% were Caucasian, median baseline age was 40 years, and 73% had exposure to antiretroviral therapy.

The researchers found 233 patients had incident fractures (crude annual rates, 59.6–93.5 fractures per 10,000 persons). Age-standardized fracture rates increased from 2000 to 2002 (57.7 per 10,000 population in 2000 to 84.8 in 2002), but then stabilized.

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Both fracture rates and relative proportion of fragility fractures were higher among HOPS patients aged 25-54 years than among the general population.

In addition to older age (over 47 years) and substance abuse, nadir CD4+ cell count

Men ages 25 through 54 in the HIV-positive cohort had significantly more fractures at the wrist and vertebra (at P

Similarly, HIV-positive women ages 25 through 54 had more fractures at the vertebra and femoral neck sites, significant at P

But both men and women in the HIV-positive cohort had relatively fewer fractures at nonfragility sites, compared with those in the outpatient survey.

The researchers cautioned that fracture incidence in the HIV-positive cohort was based on charts, and events were not confirmed by radiological findings or central adjudication.

They also noted that they did not have data for bone mineral density among those patients or use patterns for tobacco, alcohol, or other abused substances and so were unable to assess contribution of these to fracture rates.

Source reference:
Young B, et al "Increased rates of bone fracture among HIV-infected persons in the HIV Outpatient Study (HOPS) compared with the U.S. general population, 2000-2006" Clin Infect Dis 2010; 52(8): 1061-1068.

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