title: Risk of hip fracture associated with hepatitis C virus infection and hepatitis C/human immunodeficiency virus coinfection.
abstract: Hepatitis C virus (HCV) infection has been associated with reduced bone mineral density, but its association with fracture rates is unknown, particularly in the setting of human immunodeficiency virus (HIV) coinfection. Our aims were to determine whether persons with HCV infection alone are at increased risk for hip fracture, compared to uninfected individuals, and to examine whether the risk of hip fracture is higher among HCV/HIV-coinfected persons, compared to those with HCV alone, those with HIV alone, and those uninfected with either virus. We conducted a cohort study in 36,950 HCV/HIV-coinfected, 276,901 HCV-monoinfected, 95,827 HIV-monoinfected, and 3,110,904 HCV/HIV-uninfected persons within the U.S. Medicaid populations of California, Florida, New York, Ohio, and Pennsylvania (1999-2005). Incidence rates of hip fracture were lowest among uninfected persons (1.29 events/1,000 person-years), increased with the presence of either HIV infection (1.95 events/1,000 person-years) or HCV infection (2.69 events/1,000 person-years), and were highest among HCV/HIV-coinfected individuals (3.06 events/1,000 person-years). HCV/HIV coinfection was associated with an increased relative hazard (adjusted hazard ratio [HR] [95% confidence interval; CI]) of hip fracture, compared to HCV-monoinfected (HR, 1.38; 95% CI: 1.25-1.53), HIV-monoinfected (females: HR, 1.76; 95% CI: 1.44-2.16; males: HR, 1.36; 95% CI: 1.20-1.55), and HCV/HIV-uninfected persons (females: HR, 2.65; 95% CI: 2.21-3.17; males: HR, 2.20; 95% CI: 1.97-2.47). HCV monoinfection was associated with an increased risk of hip fracture, compared to uninfected individuals, and the relative increase was highest in the youngest age groups (females, 18-39 years: HR, 3.56; 95% CI: 2.93-4.32; males, 18-39 years: HR, 2.40; 95% CI: 2.02-2.84).
  
  
  CONCLUSIONS
  Among Medicaid enrollees, HCV/HIV coinfection was associated with increased rates of hip fracture, compared to HCV-monoinfected, HIV-monoinfected, and HCV/HIV-uninfected persons. HCV-monoinfected patients had an increased risk of hip fracture, compared to uninfected individuals.
authors.affiliation: Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. vincentl@mail.med.upenn.edu
authors.forename: Vincent
authors.initials: V
authors.lastname: Lo Re
authors.forename: Jessica
authors.initials: J
authors.lastname: Volk
authors.forename: Craig W
authors.initials: CW
authors.lastname: Newcomb
authors.forename: Yu-Xiao
authors.initials: YX
authors.lastname: Yang
authors.forename: Cristin P
authors.initials: CP
authors.lastname: Freeman
authors.forename: Sean
authors.initials: S
authors.lastname: Hennessy
authors.forename: Jay R
authors.initials: JR
authors.lastname: Kostman
authors.forename: Pablo
authors.initials: P
authors.lastname: Tebas
authors.forename: Mary B
authors.initials: MB
authors.lastname: Leonard
authors.forename: A Russell
authors.initials: AR
authors.lastname: Localio
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D015519:Bone Density; D016022:Case-Control Studies; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D016174:Hepacivirus; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D006620:Hip Fractures / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D015994:Incidence; D017093:Liver Failure / Q000453:epidemiology / Q000821:virology; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents