increases the risk of fractures, Danish investigators report in the online
edition of the Journal of Acquired Immune
Deficiency Syndromes. The case controlled study used data collected by
national registries in 2000.
“We report a significantly
increased prevalence of HIV infection of almost 3-fold among fracture cases,
compared to gender and age-matched controls from the Danish health registries,”
write the investigators. “This is, in our data, independent from potential
confounders, including fracture history, alcoholism, use of potentially
involved medications (sedatives, opioids, antidepressants, anticonvulsants,
antipsychotics, and corticosteroids), and annual income.”
believe their findings stress the importance of evaluating fracture risk as
part of routine HIV care.
There is a
well-established link between infection with HIV and impaired bone metabolism.
The exact reasons for this are uncertain, but possible causes include lifestyle
factors, the inflammatory effects of HIV infection and the side-effects of some
antiretroviral drugs and other medicines.
It is equally
unclear if these bone metabolism problems increase the risk of fractures, an
important question given the ageing of the HIV-infected population.
To help clarify
this pressing question, investigators in Denmark designed a retrospective
case-controlled study using data collected from national registries. The study
population included 124,655 fracture patients who were matched with 373,962
non-fracture patients of the same age and sex. The authors calculated the
association between infection with HIV and any fracture and also with fragility fractures – fractures of hip,
forearm, spine or any other fracture not related to accidents.
In calculating the
association between HIV and fracture, the investigators took into account other
factors known to have an association with fracture risk – previous fracture,
heavy alcohol use, low annual income, treatment with corticosteroids and the use of
medications affecting motor function and co-ordination.
stratified according to gender and age, and the investigators also explored the
association between the duration of HIV infection and fracture risk.
The cases and
controls had a mean age of 43 years and 52% were women.
among cases was 0.04% compared to 0.01% among the controls, a significant
difference. HIV infection was therefore associated with an almost three-fold
increase in the risk of fracture (OR = 2.98; 95% CI, 1.99-4.18).
The prevalence of
HIV infection was also significantly higher among people experiencing hip
fracture (0.03 vs < 0.01%; OR = 8.99; 95% CI, 1.39-58.0), fracture of the
forearm (0.03 vs 0.01%; OR = 3.50; 95% CI, 1.26-9.72) and fracture of the
spine (0.09 vs < 0.01%; OR = 9.0; 95% CI, 1.39-58.1).
account of all other risk factors, infection with HIV continued to be
associated with the overall risk of fractures (OR = 1.76; 95% CI, 1.14-2.71), the
association between specific types of fracture ceased to be significant.
had an almost three-fold increase in their risk of fractures compared to
HIV-negative men (OR = 2.73; 95% CI, 1.78-4.19) and HIV-positive women had an
almost four-fold increase in their risk (OR = 3.75; 95% CI, 1.48-9.50).
Comparison by age
also showed that infection with HIV was associated with an increased risk of
fracture for younger (OR = 2.76; 95% CI, 1.57-4.86) and middle-aged (OR = 3.12;
95% CI, 1.80-5.41) participants. But HIV infection was not associated with an
increased risk of fracture for people aged 60 and older.
The excess risk
associated with HIV increased with the duration of infection. The risk
increased especially rapidly during the first two to three years and then
increased more slowly.
adults are at an highly increased risk of hip and other bone fractures,
compared to the general population,” conclude the authors. “HIV-infected
patients should be assessed for fracture risk as part of their routine care.”