title: Increased risk of fragility fractures among HIV infected compared to uninfected male veterans.
abstract: BACKGROUND
  HIV infection has been associated with an increased risk of fragility fracture. We explored whether or not this increased risk persisted in HIV infected and uninfected men when controlling for traditional fragility fracture risk factors.
  
  
  RESULTS
  Cox regression models were used to assess the association of HIV infection with the risk for incident hip, vertebral, or upper arm fracture in male Veterans enrolled in the Veterans Aging Cohort Study Virtual Cohort (VACS-VC). We calculated adjusted hazard ratios comparing HIV status and controlling for demographics and other established risk factors. The sample consisted of 119,318 men, 33% of whom were HIV infected (34% aged 50 years or older at baseline, and 55% black or Hispanic). Median body mass index (BMI) was lower in HIV infected compared with uninfected men (25 vs. 28 kg/m²; p<0.0001). Unadjusted risk for fracture was higher among HIV infected compared with uninfected men [HR: 1.32 (95% CI: 1.20, 1.47)]. After adjusting for demographics, comorbid disease, smoking and alcohol abuse, HIV infection remained associated with an increased fracture risk [HR: 1.24 (95% CI: 1.11, 1.39)]. However, adjusting for BMI attenuated this association [HR: 1.10 (95% CI: 0.97, 1.25)]. The only HIV-specific factor associated with fragility fracture was current protease inhibitor use [HR: 1.41 (95% CI: 1.16, 1.70)].
  
  
  CONCLUSIONS
  HIV infection is associated with fragility fracture risk. This risk is attenuated by BMI.
authors.affiliation: VA Connecticut Healthcare System, West Haven, Connecticut, United States of America. julie.womack@va.gov
authors.forename: Julie A
authors.initials: JA
authors.lastname: Womack
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Goulet
authors.forename: Cynthia
authors.initials: C
authors.lastname: Gibert
authors.forename: Cynthia
authors.initials: C
authors.lastname: Brandt
authors.forename: Chung Chou
authors.initials: CC
authors.lastname: Chang
authors.forename: Barbara
authors.initials: B
authors.lastname: Gulanski
authors.forename: Liana
authors.initials: L
authors.lastname: Fraenkel
authors.forename: Kristin
authors.initials: K
authors.lastname: Mattocks
authors.forename: David
authors.initials: D
authors.lastname: Rimland
authors.forename: Maria C
authors.initials: MC
authors.lastname: Rodriguez-Barradas
authors.forename: Janet
authors.initials: J
authors.lastname: Tate
authors.forename: Michael T
authors.initials: MT
authors.lastname: Yin
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000502:physiology; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology*; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D015497:HIV-1 / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000453:epidemiology; D012307:Risk Factors; D012727:Sex Characteristics; D014728:Veterans / Q000706:statistics & numerical data