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One Third in Large UK HIV Survey Have Fractures, 14% of Them Osteoporotic
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Tenth International Congress on Drug Therapy in HIV Infection, November 7-11, 2010, Glasgow
Mark Mascolini
"if HIV-infected patients are at increased risk of fracture, routine assessment of fracture risk (including low bone mineral density) may be warranted in this relatively young population."
One third of British HIV patients who responded to a fracture survey reported breaking a bone at least once [1]. Among people with fractures judged to be osteoporotic, HIV infection duration was significantly longer than in people without fractures.
Between January and October 2007, researchers at Brighton and Sussex University Hospitals asked 1050 people with HIV to complete a survey on fractures and fracture risk factors, and 859 (82%) agreed. Most respondents (90%) were men, and 87% were white. Age averaged 43 years and ranged from 19 to 77, while HIV infection duration averaged 6 years and ranged from 0 to 23 years. Whereas 82% had ever taken antiretrovirals, 76% were currently being treated. Forty percent of respondents smoked cigarettes at the time of the survey, and 77% drank alcohol. Only 2% had HBV infection and 1% HCV infection.
Among the 859 respondents, 271 (31.5%) reported 437 fractures. Age at first fracture averaged 22 years (standard deviation 14 years). One quarter of all fractures occurred before the age of 12 and half before the age of 22. Another 25% of fractures happened after age 34. The investigators identified two fracture peaks, one at age 9 (22 fractures) and one at age 36 (13 fractures). On the basis of age and fracture site, the researchers figured that 62 fractures (14%) were osteoporotic fractures "definitely or possibly associated with bone fragility."
Considering all fractures reported, the Brighton-Sussex team determined that people who took oral glucocorticoids for more than 10 days were significantly more likely to break a bone (P = 0.004). Respondents who ever smoked had a significantly higher fracture risk than never-smokers (P = 0.004), but current smoking did not make fractures more likely. Neither did current alcohol drinking compared with never drinking. Ever breaking a bone was not associated with current age, body mass index, alcohol drinking, duration of HIV infection, current CD4 count, or current viral load.
Looking only at possible or probable fragility fracture, the researchers found a significantly longer HIV duration in people with a fragility fracture than in those who never broke a bone (143 versus 93 months, P < 0.0001). Body mass index tended to be lower in people with fragility fractures, but this difference from people who never broke a bone lacked statistical significance (22.8 versus 24.0 kg/m2, P = 0.143). Current cigarette smoking significantly raised the risk of fragility fractures (P = 0.032), as did ever taking glucocorticoids for more than 10 days (P = 0.008). The investigators did not attempt multivariate analyses of risks for fragility fractures or all fractures.
The researchers proposed that, "if HIV-infected patients are at increased risk of fracture, routine assessment of fracture risk (including low bone mineral density) may be warranted in this relatively young population."
Another British study presented at this conference and reviewed separately by NATAP found that remaining lifetime fracture probability at the lumbar spine was significantly greater in people with HIV than in matched HIV-negative controls [2].
References
1. Samarawickrama A, Malik R, Fisher M, Gilleece Y, Walker-Bone K. Rates of bone fractures in a cohort of HIV-infected adults in the UK. Tenth International Congress on Drug Therapy in HIV Infection. November 7-11, 2010. Glasgow. Abstract P100.
2. Peters B, Isohanni H, Tillet S, et al. Fracture risk in HIV 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.
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