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HIV infection increased risk for bone fractures

Young B. Clin Infect Dis. 2010;52:1061-1068.

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Rates for bone fractures among people with HIV were 1.98 to 3.69 times higher vs. the general US population from 2000 to 2006. Researchers for the HIV Outpatient Study, therefore, recommend for physicians to regularly assess fracture risk in those with HIV.

Older age, substance abuse, a CD4+ cell count of less than 200 cells/mm³, hepatitis C infection and diabetes were associated with incident fracture risk.

The open, prospective cohort study included 5,826 HIV-positive adults undergoing treatment across 10 US HIV clinics. Median baseline age was 40 years; 79% were men; 52% white; and 73% were exposed to antiretroviral therapy.

Researchers assessed the rates of first fracture during 2000 and 2008. The rates of fracture in the HIV Outpatient Study (HOPS) were then compared with data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) that included outpatients of the general population matched by gender and age.

During a median follow-up of 3.8 years, incident fractures were observed in 233 patients included in HOPS (59.6-93.5 fractures per 10,000 persons), of which 13.7% were hospitalized. Age-standardized fracture rates increased from 57.7 during 2000 to 84.8 during 2002 (P=.01). The rates then stabilized to 89.9 during 2008.

Both the rate for fractures and the relative proportion of fragility fractures were highest among patients aged 25 to 54 years in HOPS vs. outpatients included in NHAMCS.

“The optimal clinical management of bone health in HIV-infected individuals is not well defined and remains controversial,” Benjamin Young, MD, PhD, of the Rocky Mountain Center for AIDS Research, Education, and Services in Denver, said in a press release. “We believe our data support the need to develop guidelines that address screening for and correcting reversible causes of low bone mineral density and fall risk and that these activities should be incorporated into the routine care of HIV-infected patients.”

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