{"id":14214,"date":"2010-12-01T09:25:35","date_gmt":"2010-12-01T09:25:35","guid":{"rendered":"http:\/\/i-base.info\/htb\/?p=14214"},"modified":"2010-12-01T09:25:35","modified_gmt":"2010-12-01T09:25:35","slug":"age-raises-fracture-risk-more-in-hiv-positive-people","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/14214","title":{"rendered":"Age raises fracture risk more in HIV-positive people"},"content":{"rendered":"<p><strong>Mark Mascolini<\/strong><\/p>\n<p>Age had a greater impact on fracture risk in people with HIV than in matched controls without HIV, according to a retrospective cohort study involving<br \/>\nwell over 200,000 individuals. [1]<\/p>\n<p>Among 30-to-59-year-olds, HIV with or without AIDS independently raised the fracture risk.<\/p>\n<p>The study involved 238,336 adults continuously enrolled in the Ingenix Impact National Benchmark Database for more than 12 months from January 1997<br \/>\nthrough March 2008. Researchers studied 59,584 HIV-infected people matched 3-to-1 with HIV-negative people according to gender, month and year of<br \/>\nenrollment in the Ingenix cohort, and duration of cohort membership. They defined fracture as a low-impact nontraumatic fracture. AIDS criteria were a CD4<br \/>\ncount &lt;200 cells\/mm3 or AIDS-defining conditions.<\/p>\n<p>Nearly three quarters of HIV-positive cases and HIV-negative controls (71.5%) were men. Prevalence of several fracture risk factors were higher in the<br \/>\nHIV-positive group: excess alcohol use (2.5% versus 1.3% in controls), low weight (7.9% versus 1.6%), lipodystrophy (3.4% versus 0.04%), hepatitis B virus<br \/>\n(4.1% versus 0.2%), hepatitis C virus (6.5% versus 0.6%), and excess steroid use (5.5% versus 3.6%). But prior fracture rates were similar (2.0% among<br \/>\npeople with HIV and 1.9% in controls), as was use of proton pump inhibitors (14.5% versus 10.5%). A slightly larger proportion of controls took<br \/>\nbisphosphonates (2.0% versus 1.3% of people with HIV). Only 51% in the HIV group were taking antiretrovirals.<\/p>\n<p>Through 13,757 person-years of follow-up, 9027 people (3.8%) fractured a bone, including 4.2% with HIV and 3.7% without HIV. Fracture incidence was 14%<br \/>\nhigher in the HIV group (incidence rate ratio 1.14, 95% confidence interval [CI] 1.09 to 1.20).<\/p>\n<p>A statistical model considering numerous fracture risk factors identified five independent predictors of fracture in the entire cohort (HR, 95%CI): <\/p>\n<ul>\n<li>Prior fracture: hazard ratio (HR) 4.49 (3.89 to 5.18)<\/li>\n<li>Excess alcohol: HR 1.90 (1.65 to 2.20)<\/li>\n<li>Low physical activity: HR 1.77 (1.73<br \/>\nto 1.82)<\/li>\n<li>Anti-osteoporosis bisphosphonate use: HR 1.49 (1.29 to 1.72)<\/li>\n<li>Low weight: HR 1.32 (1.18 to 1.48)<\/li>\n<\/ul>\n<p> The researchers<br \/>\nthen identified independent fracture risk factors in three age groups:<\/p>\n<p><strong>People under 30<\/strong> <\/p>\n<ul>\n<li>Prior fracture: HR 7.77 (3.23 to 18.67)<\/li>\n<li>Excess alcohol: HR 2.24 (1.06 to 4.74)<\/li>\n<\/ul>\n<p><strong>People 30 to 59 years old<\/strong> <\/p>\n<ul>\n<li>Prior fracture: HR 3.81 (3.14 to 4.63)<\/li>\n<li>Low physical activity: HR 2.24 (1.90 to 2.65)<\/li>\n<li>Excess alcohol: HR 1.86 (1.55 to 2.23)<\/li>\n<li>Anti-osteoporosis bisphosphonate use: HR 1.36 (1.20 to 1.68)<\/li>\n<li>Low weight: HR 1.30 (1.12 to<br \/>\n1.50)<\/li>\n<li>HIV without AIDS: HR 1.18 (1.09 to 1.28)<\/li>\n<li>HIV with AIDS: HR 1.15 (1.06 to 1.26)<\/li>\n<li>Vitamin D deficiency or D or calcium<br \/>\nsupplementation: HR 0.72 (0.54 to 0.98)<\/li>\n<\/ul>\n<p> <strong>People older than 59<\/strong> <\/p>\n<ul>\n<li>Prior fracture: HR 2.79 (1.68 to 4.64)<\/li>\n<li>Low<br \/>\nphysical activity: HR 2.65 (1.67 to 4.21)<\/li>\n<\/ul>\n<p> The researchers could not explain why vitamin D deficiency or vitamin D or calcium supplementation<br \/>\nwas protective in their analysis.<\/p>\n<p>Linear trend analysis showed that, compared with HIV-negative people, fracture risk rose significantly more with advancing age among HIV-infected people<br \/>\nwithout AIDS (p=0.012) or with AIDS (p=0.001). The increased fracture trend with age in HIV-infected people was higher in those with AIDS than in those<br \/>\nwithout AIDS.<\/p>\n<p>The investigators noted that their analysis suffered from lack of data on bone mineral density, race, and over-the-counter drugs. Only 6% of people<br \/>\nanalysed reported smoking, so the researchers did not including smoking in the analysis.<\/p>\n<p>An earlier comparison of 8,525 people with HIV and 2,208,792 people without HIV in a Boston healthcare system found significantly higher fracture<br \/>\nprevalence in both men and women with HIV than in uninfected men and women. [2]<\/p>\n<p>References: <\/p>\n<ol>\n<li>Mundy LM, St. Laurent S. Bowlin S, et al. Age-stratified risk assessment for fracture among adults with and without HIV infection.<br \/>\n1st International Workshop on HIV and Aging. 4-5 October 2010. Abstract O_07.<\/li>\n<li>Triant VA, Brown TT, Lee H, Grinspoon SK. Fracture prevalence<br \/>\namong human immunodeficiency virus (HIV)-infected versus non-HIV-infected patients in a large U.S. healthcare system. J Clin Endocrinol Metab.<br \/>\n2008;93:3499-3504.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Mark Mascolini Age had a greater impact on fracture risk in people with HIV than in matched controls without HIV, according to a retrospective cohort study involving well over 200,000 individuals. [1] Among 30-to-59-year-olds, HIV with or without AIDS independently &hellip;<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,27],"tags":[86],"class_list":["post-14214","post","type-post","status-publish","format-standard","hentry","category-conference-reports","category-weight-diabetes-metabolic-complications","tag-hiv-and-ageing-2010"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/14214","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=14214"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/14214\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=14214"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=14214"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=14214"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}