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Original article

Low bone mineral density and risk of incident fracture in HIV-infected adults

Linda Battalora, Kate Buchacz, Carl Armon, Edgar T Overton, John Hammer, Pragna Patel, Joan S Chmiel, Kathy Wood, Timothy J Bush, John R Spear, John T Brooks, Benjamin Young, the HIV Outpatient Study (HOPS) and SUN Study Investigators

Corresponding author name: Linda Battalora
Corresponding author e-mail: LBattalo@mines.edu

Citation: Antiviral Therapy 2016; 21:45-54
doi: 10.3851/IMP2979

Date accepted: 22 June 2015
Date published online: 21 July 2015

Abstract

Background: Prevalence rates of low bone mineral density (BMD) and bone fractures are higher among HIV-infected adults compared with the general United States (US) population, but the relationship between BMD and incident fractures in HIV-infected persons has not been well described.

Methods: Dual energy X-ray absorptiometry (DXA) results of the femoral neck of the hip and clinical data were obtained prospectively during 2004–2012 from participants in two HIV cohort studies. Low BMD was defined by a T-score in the interval >-2.5 to <-1.0 (osteopenia) or ≤-2.5 (osteoporosis). We analysed the association of low BMD with risk of subsequent incident fractures, adjusted for sociodemographics, other risk factors and covariables, using multivariable proportional hazards regression.

Results: Among 1,006 participants analysed (median age 43 years [IQR 36–49], 83% male, 67% non-Hispanic white, median CD4+ T-cell count 461 cells/mm3 [IQR 311–658]), 36% (n=358) had osteopenia and 4% (n=37) osteoporosis; 67 had a prior fracture documented. During 4,068 person-years of observation after DXA scanning, 85 incident fractures occurred, predominantly rib/sternum (n=18), hand (n=14), foot (n=13) and wrist (n=11). In multivariable analyses, osteoporosis (adjusted hazard ratio [aHR] 4.02, 95% CI 2.02, 8.01) and current/prior tobacco use (aHR 1.59, 95% CI 1.02, 2.50) were associated with incident fracture.

Conclusions: In this large sample of HIV-infected adults in the US, low baseline BMD was significantly associated with elevated risk of incident fracture. There is potential value of DXA screening in this population.

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