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Lifetime Spine Fracture Risk Greater With Than Without HIV in UK Comparison
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Tenth International Congress on Drug Therapy in HIV Infection, November 7-11, 2010, Glasgow
Mark Mascolini
Remaining lifetime fracture probability (RLFP) at the lumbar spine was significantly greater in people with HIV than in a matched HIV-negative control population, according to results of UK study [1]. More people with than without HIV had osteopenia or osteoporosis. And starting antiretroviral therapy more than quadrupled the risk of low bone mineral density in this analysis at Kings College London and St. Thomas' Hospital.
This cross-sectional case-control comparison involved 223 randomly selected HIV patients and age- and gender-matched controls. All study participants underwent DEXA scans of the lumbar spine, femoral neck, and total hip to calculate bone mineral density. They also completed an extensive questionnaire on bone disease risk factors, and the researchers measured an array of lab values that may affect bone. The investigators also calculated a FRAX score (which gauges 10-year probability of major fractures) and figured RLFP at the three DEXA sites for each study participant.
The HIV group included 133 men (60%), 106 whites (48%), and 73 people (33%) with an AIDS diagnosis. Among the 190 HIV-positive people (85%) taking antiretrovirals, 50 (22% of 223) were taking their first regimen.
The researchers detected World Health Organization-defined osteopenia in 39% of men and 29% of women with HIV, while detecting osteoporosis in 13% of men and 11% of women. The osteopenia rate was 3.0 times higher in HIV patients than in HIV-negative age-matched controls, and the osteoporosis rate 2.4 times higher.
Overall FRAX-determined 10-year fracture risk stood at 3.16% in people with HIV, and 2.0% in HIV-negative people, a nonsignificant difference. Average RLFP did not differ significantly between the groups for the total hip or femoral neck. But for the spine, average FLFP was significantly higher in the HIV group (2.8 versus 1.69, P = 0.002). In statistical analysis adjusted for age and gender, spine RLFP was higher in the HIV group (adjusted odds ratio [AOR] 1.22, 95% confidence interval [CI] 1.07 to 1.40, P = 0.003). This odds ratio held when the investigators considered only whites.
Starting antiretroviral therapy independently more than quadrupled the risk of low bone mineral density (AOR 4.43, 95% CI 1.57 to 12.50, P = 0.005). Body mass index, alkaline phosphatase, and testosterone levels were also associated with bone mineral density, but gender, ethnicity, current and lowest-ever CD4 count, and vitamin D level were not.
The researchers proposed that "screening for bone mineral density and risk factors for fragility fractures is indicated in patients with HIV at a younger age than in the general population," especially if they are taking antiretrovirals.
A large case-control study in the United States documented significantly higher fracture prevalence in both men and women with HIV than in uninfected men and women [2].
References
1. Peters B, Isohanni H, Tillet S, et al. Fracture risk in IHV and the need for guidelines: the Probono-1 trial. Tenth International Congress on Drug Therapy in HIV Infection. November 7-11, 2010. Glasgow. Abstract P099.
2. Triant VA, Brown TT, Lee H, Grinspoon SK. Fracture prevalence among human immunodeficiency virus (HIV)-infected versus non-HIV-infected patients in a large U.S. healthcare system. J Clin Endocrinol Metab. 2008;93:3499-3504.
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