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

Academic Article


  • 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 deined 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 personyears 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 signiicantly associated with elevated risk of incident fracture. There is potential value of DXA screening in this population.
  • Authors

    Published In

  • Antiviral Therapy  Journal
  • Digital Object Identifier (doi)

    Author List

  • Battalora L; Buchacz K; Armon C; Overton ET; Hammer J; Patel P; Chmiel JS; Wood K; Bush TJ; Spear JR
  • Start Page

  • 45
  • End Page

  • 54
  • Volume

  • 21
  • Issue

  • 1