November 22, 2012
Overall, ART-treated participants had a greater risk for hip fracture (about two-fold) compared to uninfected people. In general, for co-infected men and women fracture risk rose with age.
Overall, ART-using co-infected participants had a greater risk for hip fracture than ART-using participants with HIV monoinfection. This increased risk differed by gender, with co-infected ART-using women having a 76% increased risk and co-infected ART-using men having a 36% increased risk for hip fracture.
Among all HIV-HCV co-infected people, there was a 38% increased risk for hip fracture compared to HCV-monoinfected people.
1. HIV-HCV co-infected people who use ART have increased risk for hip fractures compared to the following groups of people:
2. HCV-monoinfected people have increased risk for hip fracture compared to people without HCV (or HIV) who are under the age of 70.
Researchers are not certain why there was an increased risk for hip fractures among HCV-positive people. We have already mentioned the potential impact of chronic inflammation and liver injury on bone health. However, more research needs to be done to fully understand the general impact of chronic HCV infection on bone health.
The research team noted that certain factors that are relatively common among some HCV-positive people could also play a role in the loss of bone mineral density, including the following:
Their data set did not include these missing factors and that is one weakness that may have affected the study's conclusions.
Other studies have found that HIV-positive people (and even some people at high risk for HIV infection) tend to have reduced bone mineral density. The reason(s) for this are not clear. Chronic HIV infection also causes inflammation that is only partially reduced with treatment. Less-than-optimal levels of vitamin D are also relatively common in HIV-positive people. Deficiencies of testosterone, reduced muscle mass and perhaps other factors could play a role in thinning bones as well.
The researchers attempted to assess the impact on bone health of anti-HIV drugs that were prescribed for participants' initial treatment. However, due to built-in limitations of the study's retrospective design, researchers cannot draw firm conclusions about the long-term impact of such drugs on the risk of hip fracture.
The study is unusual because of its immense size, and this is a great strength. That the researchers compared different groups of people with and without different viral infections is another strength. The study's findings are generally sound -- there is an increased risk for hip fractures among people with HCV infection, including people who are co-infected with HCV and HIV. A previous French study has also found an increased risk for fractures among co-infected people.
Now other research teams need to investigate precisely why HCV is associated with reduced bone mineral density and explore interventions that can improve bone health in people with HCV monoinfection as well as those with HCV-HIV co-infection.
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