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Severity of Illness and Fracture Risk: risk factors in HIV for bone fracture in Veterans & Aging Cohort/Men
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Reported by Jules Levin
IAC 2012
Julie A. Womack, CNM, APRN, PhD1; Joseph L. Goulet, PhD2,3; Cynthia Gibert, MD, MSc4; Cynthia Brandt, MD, MPH2, 5; Melissa Skanderson, MSW1; Janet Tate, ScD1; Barbara Gulanski, MD, MPH2, 6; David Rimland, MD7; Maria C. Rodriguez-Barradas, MD8; Michael Yin, MD9; Amy C. Justice, MD, PhD1,6
Yale School of Nursing, New Haven, CT, USA; 2. VA Connecticut Healthcare System, West Haven, CT, USA; 3. Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; 4. Section of Infectious Diseases, Department of Medicine, George Washington University and VA Medical Center Washington, DC, USA; 5. Yale Center for Medical Informatics, Yale University, New Haven, CT, USA; 6. Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA; 7. Veterans Affairs Medical Center and Emory University School of Medicine, Atlanta, GA, USA; 8. Medical Service, Michael E. De Bakey Veterans Affairs Medical Center and Department of Medicine, Baylor College of Medicine, Houston, TX, USA; 9. Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, NY, USA
BACKGROUND
An estimated 1 million individuals in the United States are infected with HIV. Although fractures are a rare occurrence, their cost to both patients and the health care system merit sustained attention. Research must identify modifiable risk factors that can be the target of interventions. Prior research suggests that severity of illness plays a role in fracture risk among HIV infected (HIV+) individuals, but CD4 count and HIV-RNA have been inconsistently associated with fractures. The VACS Index is a composite score based on measures obtained from routine clinical data: age, CD4 count, HIV-RNA, hemoglobin, AST, ALT, platelets, creatinine, and Hepatitis C status. The VACS Index has been shown to be a novel predictor of five-year mortality and ICU admissions for HIV+ individuals, and thus may capture illness severity. Higher scores indicate greater disease severity. We explored the association of traditional and HIV-specific risk factors for fragility fracture when controlling for the VACS Index as a time-updated covariate.
METHODS
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