HIV infection and increased fracture risk: Study

By Dr. Ananya Mandal, MDMar 14 2011

According to a latest study, adults between ages 25 and 54 infected with HIV, are at increased risk for bone fractures compared to the general population. Until now it was known that low bone mineral density was common in people with HIV, but no concrete proof existed.

For this study the researchers compared rates of bone fractures in 5,826 HIV-infected patients between 2000 and 2008 and people in the general U.S. population between 2000 and 2006. The data came from the HIV Outpatient Study (HOPS), which is an open prospective cohort study of HIV-infected adults. Follow-up was conducted at 10 HIV clinics in the United States between 2000 and 2008. The researchers noted the rates of first fractures at any anatomic site. The annual bone fracture rates were between 1.98 and 3.69 times higher among the HIV-infected patients. The findings appear Mar. 11 in the journal Clinical Infectious Diseases.

Study author Dr. Benjamin Young of the Rocky Mountain Center for AIDS Research, Education and Services in Denver said, “We confirmed that several established risk factors for fracture, such as age, substance abuse, hepatitis C co-infection and diabetes were associated with fractures among HIV-infected patients…This study also highlights for the first time a potential association between fracture risk and CD4 cell count.” CD4 cells are immune system cells that HIV infects and destroys. He added, “The optimal clinical management of bone health in HIV-infected individuals is not well defined and remains controversial.” But these findings “support the need to develop guidelines that address screening for - and correcting - reversible causes of low bone mineral density and fall risk,” he added, noting that these activities “should be incorporated into the routine care of HIV-infected patients.”

There is no current consensus for the clinical management of bone health in HIV-infected individuals. The European AIDS Clinical Society recommends screening HIV-infected adults for fracture risk at age 40 years and older, whereas other recommendations suggest screening at age 50 years and older.

Michael Archdeacon, MD, professor of orthopedic surgery at the University of Cincinnati College of Medicine in Ohio said, “I’m going to be a little more in tune to my [HIV-infected] patients’ bone density at a younger age, making sure they’re getting adequate calcium and vitamin D in their diet. They might be candidates for bisphosphonate therapy to decrease bone density loss.”

The study was supported by the Centers for Disease Control and Prevention. One of the authors has received research support from Cerner, Gilead Sciences, Merck, and GlaxoSmithKline and is a member of advisory boards or speaker's bureaus for GlaxoSmithKline, Merck, and ViiV Healthcare.