Increased risk of fragility fractures among HIV infected compared to uninfected male veterans

• Published in: PloS one Vol. 6; no. 2; p. e17217
• Main Authors: Womack, Julie A, Goulet, Joseph L, Gibert, Cynthia, Brandt, Cynthia, Chang, Chung Chou, Gulanski, Barbara, Fraenkel, Liana, Mattocks, Kristin, Rimland, David, Rodriguez-Barradas, Maria C, Tate, Janet, Yin, Michael T, Justice, Amy C
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 16.02.2011; Public Library of Science (PLoS)
• Subjects: Abuse; Aged; Aged, 80 and over; Aging; Alcohol abuse; Alcohol use; Alcoholic beverages; Alcoholism; Antiretroviral drugs; Body mass; Body mass index; Body size; Bone Density - physiology; Comorbidity; Comparative analysis; Demographics; Demography; Drug abuse; Follow-Up Studies; Fractures; Fractures (Injuries); Fractures, Bone - epidemiology; Fractures, Bone - etiology; Fragility; Health aspects; Health risk assessment; Health risks; Hip; HIV; HIV infections; HIV Infections - complications; HIV Infections - epidemiology; HIV patients; HIV-1 - physiology; Human immunodeficiency virus; Humans; Infection; Infections; Male; Medical research; Medicine; Men; Middle Aged; Osteoporosis - complications; Osteoporosis - epidemiology; Protease inhibitors; Proteases; Regression analysis; Regression models; Risk analysis; Risk Factors; Sex Characteristics; Smoking; Vacuum cleaners; Vertebrae; Veterans - statistics & numerical data; United States > US; Connecticut
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0017217

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. 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)]. HIV infection is associated with fragility fracture risk. This risk is attenuated by BMI.