Increased Risk of Fragility Fractures Among HIV Infected Compared to Uninfected Male Veterans

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2011 Mar 2

PMID 21359191

Citations 133

Authors

Julie A Womack

Joseph L Goulet

Cynthia Gibert

Cynthia Brandt

Chung Chou Chang

Barbara Gulanski

Liana Fraenkel

Kristin Mattocks

David Rimland

Maria C Rodriguez-Barradas

Janet Tate

Michael T Yin

Amy C Justice

Affiliations

Soon will be listed here.

Abstract

Background: HIV infection has been associated with an increased risk of fragility fracture. We explored whether or not this increased risk persisted in HIV infected and uninfected men when controlling for traditional fragility fracture risk factors.

Methodology/principal Findings: Cox regression models were used to assess the association of HIV infection with the risk for incident hip, vertebral, or upper arm fracture in male Veterans enrolled in the Veterans Aging Cohort Study Virtual Cohort (VACS-VC). We calculated adjusted hazard ratios comparing HIV status and controlling for demographics and other established risk factors. The sample consisted of 119,318 men, 33% of whom were HIV infected (34% aged 50 years or older at baseline, and 55% black or Hispanic). Median body mass index (BMI) was lower in HIV infected compared with uninfected men (25 vs. 28 kg/m²; p<0.0001). Unadjusted risk for fracture was higher among HIV infected compared with uninfected men [HR: 1.32 (95% CI: 1.20, 1.47)]. After adjusting for demographics, comorbid disease, smoking and alcohol abuse, HIV infection remained associated with an increased fracture risk [HR: 1.24 (95% CI: 1.11, 1.39)]. However, adjusting for BMI attenuated this association [HR: 1.10 (95% CI: 0.97, 1.25)]. The only HIV-specific factor associated with fragility fracture was current protease inhibitor use [HR: 1.41 (95% CI: 1.16, 1.70)].

Conclusions/significance: HIV infection is associated with fragility fracture risk. This risk is attenuated by BMI.

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