title: Incident fractures in HIV-infected individuals: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Some but not all studies indicate that individuals with HIV infection are at an increased risk of fracture. We systematically reviewed the literature to investigate whether incidence of fracture (both overall and fragility) differs between individuals with and without HIV.
  
  
  METHODS
  A systematic review and meta-analysis.
  
  
  METHODS
  Medline, Scopus and the Cochrane Library databases for all studies ever published up to 28 September 2012 and electronically available conference abstracts from CROI, ASBMR, IAS and AIDS were searched. All studies reporting incidence of all fracture and fragility fracture in HIV-infected adults were included. A random effects model was used to calculate pooled estimates of incidence rate ratios (IRRs) for studies that presented data for HIV-infected and controls. For all studies, incidence rates of fracture and predictors of fracture among HIV-infected individuals were summarized.
  
  
  RESULTS
  Thirteen eligible studies were analysed, of which seven included controls. Nine studies reported all incident fractures and 10 presented incident fragility fractures. The pooled IRR was 1.58 [95% confidence interval (CI) 1.25-2.00] for all fracture and 1.35 (95% CI 1.10-1.65) for fragility fracture. Smoking, white race and older age were consistent predictors for fragility fractures.
  
  
  CONCLUSIONS
  Our results indicate that HIV infection is associated with a modest increase in incident fracture. Future research should focus on clarifying risk factors, designing appropriate interventions and the long-term implications of this increased risk for an ageing HIV-infected population.
authors.affiliation: aGertrude H. Sergievsky Center bDepartment of Epidemiology, Mailman School of Public Health cDepartment of Medicine, Division of Infectious Disease dDepartment of Pediatrics, Columbia University Medical Center, New York, New York, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Shiau
authors.forename: Emily C
authors.initials: EC
authors.lastname: Broun
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Arpadi
authors.forename: Michael T
authors.initials: MT
authors.lastname: Yin
mesh_terms: D050723:Fractures, Bone / Q000453:epidemiology*; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D015994:Incidence