TY - JOUR
T1 - Low bone mineral density and risk of incident fracture in HIV-infected adults
AU - Battalora, Linda
AU - Buchacz, Kate
AU - Armon, Carl
AU - Overton, Edgar T.
AU - Hammer, John
AU - Patel, Pragna
AU - Chmiel, Joan S.
AU - Wood, Kathy
AU - Bush, Timothy J.
AU - Spear, John R.
AU - Brooks, John T.
AU - Young, Benjamin
PY - 2016
Y1 - 2016
N2 - 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.
AB - 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.
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U2 - 10.3851/IMP2979
DO - 10.3851/IMP2979
M3 - Article
C2 - 26194468
AN - SCOPUS:84964583047
SN - 1359-6535
VL - 21
SP - 45
EP - 54
JO - Antiviral Therapy
JF - Antiviral Therapy
IS - 1
ER -
