Low BMD, age increased fracture risk in adults with HIV

BRUSSELS — Low bone mineral density and increasing age are significant factors in the increased risk for incident fractures in adults with HIV, according to data presented at EACS 2013.

“We know that as our population is getting older that patients are likely more at risk of fracture, and we are seeing higher fracture rates in patients with HIV. We also see higher rates of low bone density in patients with HIV. So in our population, age is the question — are the two linked? Are the patients with low bone mass density actually having more fractures? For the first time, through a collaborative study of over 1,000 patients, we’ve actually been able to define that link between having low bone mass density and having increased fracture rates,” Patrick WG Mallon, PhD, MB, BCh, BAO, group leader, HIV Molecular Research Group, University College Dublin, said during a presentation.

The dual energy X-ray absorptiometry (DXA) values of 1,008 patients were analyzed in conjunction with clinical data collected from 2004 to 2012 by two CDC-sponsored HIV cohort studies. Continuous variables, such as osteopenia or osteoporosis, were determined using the Jonckheere-Terpstra test. Researchers assessed categorical factors using the Cochran-Armitage test.

Researchers found that 36.3% of patients (median age, 42 years) had osteopenia and 2.9% had osteoporosis. During the period of observation after DXA scanning, 95 incident fractures occurred, mainly rib/sternum (n=18), hand (n=17), foot (n=15), and wrist (n=11). Low bone mineral (BMD) density was significantly associated (P<.05) with age, lower nadir CD4, history of fracture, and male-male sex HIV transmission risk.

“There have been a lot of studies that have been previously published that have consistently shown higher rates of fractures in people with HIV. The big difference with this study is that they’ve been able to link low bone density to fractures,” Mallon said. “In the past, it always been [thought] as: Are we seeing high fracture rates because people living with HIV are in some way different from the general population in terms of their risk or their fragility? Or is it actually something that has a pathological basis? This study suggests that there is a pathological element to it. When you control for a lot of other factors, there is still this single association with low bone density and fractures. That’s a big step in a study of 1,000 patients.”

For more information:

Battalora L. Abstract # PS1/4. Presented at: 14th European AIDS Conference; Oct. 16-19, 2013; Brussels.