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People with HIV Have Higher Bone Fracture Risk in Danish Study

Being HIV positive was associated with a nearly 3-fold greater likelihood of bone fractures overall -- and a 9-fold higher risk of hip and spine fractures -- compared with HIV negative people, according to results from a large Danish population study described in the May 1 Journal of Acquired Immune Deficiency Syndromes.

Research has shown that people with HIV have lower bone density, on average, than HIV negative individuals, but the reasons for this are not fully understood.

Some antiretroviral drugs -- notably tenofovir (Viread, also in the Truvada, Atripla, Complera, and Stribild coformulations) and protease inhibitors -- are associated with bone loss, and inflammation and metabolic changes related to chronic HIV infection may also play a role. Studies are less clear about whether changes in bone density have clinical consequences, especially increased risk of fractures.

Daniel Prieto-Alhambra from the University of Oxford and colleagues looked at the association between clinical diagnosis of HIV infection and fracture risk in a

case-control study using data from the Danish National Health Service registries. The analysis included 124,655 people who sustained bone fractures and 373,962 age- and sex-matched control subjects without fractures.

Results

• A total of 50 people in the fracture group were diagnosed with HIV, or 0.40 per 1000.
• A total of 52 people in the much larger no fracture group had HIV, or 0.14 per 1000.
• The risk of any fracture was significantly higher among HIV positive participants, with an age- and sex-matched odds ratio (OR) of 2.89, or nearly 3 times higher risk.
• HIV positive people also had significant higher risk of fractures at specific sites including the hip (OR 8.99), forearm (OR 3.50), and spine (OR 9.00).

"HIV infection is associated with an almost 3-fold increase in fracture risk compared with that of age- and gender-matched uninfected patients," the researchers concluded. "HIV patients are also at an almost 9-fold higher risk of hip fracture."

5/28/14

Reference

D Prieto-Alhambra, R Güerri-Fernández, F De Vries, et al. HIV Infection and Its Association With an Excess Risk of Clinical Fractures: A Nationwide Case-Control Study. Journal of Acquired Immune Deficiency Syndromes 66(1):90-95. May 1, 2014.