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HIV infection was associated with an increased risk of hip fracture, independently of age, gender and co-morbidities: a population-based cohort study
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Rapporteur report
Track B report by Jurgen Rockstroh
study by Knobel et al. studied the risk of fractures in HIV+ versus HIV- subjects. They found a strong association between HIV infection and hip fracture incidence , with an almost 5-fold increased risk in the HIV-infected patients, independently of gender, age, body mass index, smoking, alcohol consumption and other co-morbidities. Overall, a 75% higher risk of all clinical fractures among HIV-infected patients was found underlining the need for more bone research in this patient population.
HIV infection was associated with an increased risk of hip fracture, independently of age, gender and co-morbidities: a population-based cohort study
Presented by Hernando Knobel (Spain).
H. Knobel1, R. Guerri1, D. Prieto2, J. Villar1, A. Diez3, E. Lerma1, M. Montero1, A. Gonzalez1, A. Guelar1
1Hospital del Mar, Infectious Diseases, Barcelona, Spain, 2Universitat Aut˜noma de Barcelona, IDIAP Jordi Gol Primary Care Research Institute, Barcelona, Spain, 3Hospital del Mar, Internal Medicine, Barcelona, Spain
Background: HIV infection and anti-retroviral therapies have detrimental effects on bone metabolism, a high prevalence of osteopenia and osteoporosis has been described in HIV-infected patients, but data on their impact on fracture risk are controversial.
Methods: A population-based cohort study was conducted to explore the association between HIV infection and hip and other major osteoporotic fracture risk. Data was obtained from the SIDIAPQ Database, which contains clinical information for >2 million patients in Catalonia, Spain (30% of the total population). We screened the database to identify participants with a diagnosis of HIV infection, and ascertained incident hip and osteoporotic major fractures (clinical spine, wrist/forearm, pelvis and proximal humerus) in the population aged 40 years or older in the period 2007-2009. In addition, we obtained data on incident fractures involving hospital admission from the Hospital Discharge Episodes database. Cox regression models were used to estimate Hazard Ratios (HRs) and 95% CI for the HIV-infected VS uninfected participants. Models were adjusted for age, gender, body mass index (BMI), smoking status, alcohol consumption, oral glucocorticoid use, and co-morbid conditions (as the Charlson Index).
Results: Among 1,118,156 eligible participants, we identified 2,489 (0.22%) subjects with a diagnosis of HIV/AIDS, with a median follow-up of 3 years. During the study 41,907 (3.75%) patients died, 178 (7.2%) of HIV-infected and 41,729 (3.7%) of the uninfected population). During the study 49 and 24,408 of clinical fractures (12 and 7,299 hip fractures) were observed in the HIV-infected and in the uninfected patients respectively.
The unadjusted fracture incidence rates were 8.03/1,000 patient-years (95%CI 6.07-10.62) in the HIV-infected and 7.93/1,000 (7.83-8.03) in the non-infected patients. The HR for hip fracture in HIV/AIDS was 4.7 (2.4-9.5; p< 0.001) and for all clinical fractures was 1.8 (1.2-2.5; p=0.002) in the adjusted model including all potential confounders.
Conclusion: A strong association between HIV infection and hip fracture incidence was found, with an almost 5-fold increased risk in the HIV-infected patients, independently of gender, age, body mass index, smoking, alcohol consumption and co-morbidities. Similarly, a 75% higher risk of all clinical fractures was found among HIV-infected patients.
IR = incidence rate; py = person-years at risk; CI = confidence interval.
aFurther adjusted for body mass index, smoking, alcohol use, oral corticosteroid use, and the following comorbid conditions (as listed in the Charlson comorbidity index): type 2 diabetes, chronic obstructive pulmonary disease, heart failure, myocardial infarction, rheumatoid arthritis, cardiovascular disease, peripheral vascular disease, renal failure, liver disease, malignancy, paraplegia, ulcer, and dementia.
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