title: Physiologic frailty and fragility fracture in HIV-infected male veterans.
abstract: BACKGROUND
  The Veterans Aging Cohort Study (VACS) Index is associated with all-cause mortality in individuals infected with human immunodeficiency virus (HIV). It is also associated with markers of inflammation and may thus reflect physiologic frailty. This analysis explores the association between physiologic frailty, as assessed by the VACS Index, and fragility fracture.
  
  
  METHODS
  HIV-infected men from VACS were included. We identified hip, vertebral, and upper arm fractures using ICD-9-CM codes. We used Cox regression models to assess fragility fracture risk factors including the VACS Index, its components (age, hepatitis C status, FIB-4 score, estimated glomerular filtration rate, hemoglobin, HIV RNA, CD4 count), and previously identified risk factors for fragility fractures.
  
  
  RESULTS
  We included 40 115 HIV-infected male Veterans. They experienced 588 first fragility fractures over 6.0 ± 3.9 years. The VACS Index score (hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.11-1.19), white race (HR, 1.92; 95% CI, 1.63-2.28), body mass index (HR, 0.94; 95% CI, .92-.96), alcohol-related diagnoses (HR, 1.65; 95% CI, 1.26-2.17), cerebrovascular disease (HR, 1.95; 95% CI, 1.14-3.33), proton pump inhibitor use (HR, 1.87; 95% CI, 1.54-2.27), and protease inhibitor use (HR, 1.25; 95% CI, 1.04-1.50) were associated with fracture risk. Components of the VACS Index score most strongly associated with fracture risk were age (HR, 1.40; 95% CI, 1.27-1.54), log HIV RNA (HR, 0.91; 95% CI, .88-.94), and hemoglobin level (HR, 0.82; 95% CI, .78-.86).
  
  
  CONCLUSIONS
  Frailty, as measured by the VACS Index, is an important predictor of fragility fractures among HIV-infected male Veterans.
authors: Yale School of Nursing, New Haven, CT, USA. julie.womack@yale.edu
authors: Julie A
authors: JA
authors: Womack
authors: Joseph L
authors: JL
authors: Goulet
authors: Cynthia
authors: C
authors: Gibert
authors: Cynthia A
authors: CA
authors: Brandt
authors: Melissa
authors: M
authors: Skanderson
authors: Barbara
authors: B
authors: Gulanski
authors: David
authors: D
authors: Rimland
authors: Maria C
authors: MC
authors: Rodriguez-Barradas
authors: Janet
authors: J
authors: Tate
authors: Michael T
authors: MT
authors: Yin
authors: Amy C
authors: AC
authors: Justice
mesh_terms: D000328:Adult; D015331:Cohort Studies; D050723:Fractures, Bone / Q000453:epidemiology / Q000821:virology*; D015658:HIV Infections / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012044:Regression Analysis; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*
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