March 14, 2011
Low bone mineral density is common among HIV patients, but data on their risk of fractures are limited, the authors wrote. To assess the risk, they analyzed data from HOPS, an open prospective cohort study of HIV-positive adults at 10 U.S. HIV clinics, during 2002-08. Rates of fracture at any site 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). Investigators examined fracture-associated factors using Cox proportional hazards modeling.
Of 5,826 HOPS patients included in the analysis (median baseline age, 40 years; male sex, 79 percent; white race, 52 percent; antiretroviral exposed, 73 percent), 233 patients had incident fractures (crude annual rates, 59.6-93.5 per 10,000 persons). Standardized by age, fracture rates increased between 2000 and 2002 (P=.01), but stabilized in subsequent years.
Fracture rates and relative proportion of fragility fractures were higher among HOPS patients ages 25-54 than NHAMCS-OPD patients in the same age group. Incident fractures were associated with older age, substance abuse, nadir CD4+ cell count below 200 cells/mm3 (adjusted hazard ratio [aHR], 1.60; 95 percent confidence interval [CI], 1.11-2.31), hepatitis C infection (aHR, 1.61; 95 percent CI, 1.13-2.29) and diabetes (aHR, 1.62; 95 percent CI, 1.00-2.64).
"Age-adjusted fracture rates among HOPS patients were higher than rates in the general population during the period 2000-2006," concluded the study authors. "Clinicians should regularly assess HIV-infected persons for fracture risk, especially those with low nadir CD4+ cell counts or other established risk factors for fracture."
Clinical Infectious Diseases
03.10.2011; doi: 10.1093/cid/ciq242; Benjamin Young; Christine N. Dao; Kate Buchacz; Rose Baker; John T. Brooks; and the HIV Outpatient Study Investigators
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