title: A cross-sectional randomised study of fracture risk in people with HIV infection in the probono 1 study.
abstract: OBJECTIVE
  To determine comparative fracture risk in HIV patients compared with uninfected controls.
  
  
  METHODS
  A randomised cross-sectional study assessing bone mineral density (BMD), fracture history and risk factors in the 2 groups.
  
  
  METHODS
  Hospital Outpatients.
  
  
  METHODS
  222 HIV infected patients and an equal number of age-matched controls.
  
  
  METHODS
  Fracture risk factors were assessed and biochemical, endocrine and bone markers measured. BMD was assessed at hip and spine. 10-year fracture probability (FRAX) and remaining lifetime fracture probability (RFLP) were calculated.
  
  
  METHODS
  BMD, and history of fractures.
  
  
  RESULTS
  Reported fractures occurred more frequently in HIV than controls, (45 vs. 16; 20.3 vs. 7%; OR=3.27; p=0.0001), and unsurprisingly in this age range, non-fragility fractures in men substantially contributed to this increase. Osteoporosis was more prevalent in patients with HIV (17.6% vs. 3.6%, p<0.0001). BMD was most reduced, and predicted fracture rates most increased, at the spine. Low BMD was associated with antiretroviral therapy (ART), low body mass index and PTH. 10-year FRAX risk was <5% for all groups. RLFP was greater in patients with HIV (OR=1.22; p=0.003) and increased with ART (2.4 vs. 1.50; OR= 1.50; p=0.03).
  
  
  CONCLUSIONS
  The increased fracture rate in HIV patients in our relatively youthful population is partly driven by fractures, including non-fragility fractures, in men. Nonetheless, these findings may herald a rise in osteoporotic fractures in HIV patients. An appropriate screening and management response is required to assess these risks and identify associated lifestyle factors that are also associated with other conditions such as cardiovascular disease and diabetes.
authors.affiliation: Department of Infectious Diseases, Kings College London, London, United Kingdom ; Honorary Consultant Physician, Guys and St Thomas' Foundation Hospitals, London, United Kingdom.
authors.forename: Barry S
authors.initials: BS
authors.lastname: Peters
authors.forename: Melissa
authors.initials: M
authors.lastname: Perry
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Wierzbicki
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Wolber
authors.forename: Glen M
authors.initials: GM
authors.lastname: Blake
authors.forename: Nishma
authors.initials: N
authors.lastname: Patel
authors.forename: Richard
authors.initials: R
authors.lastname: Hoile
authors.forename: Alastair
authors.initials: A
authors.lastname: Duncan
authors.forename: Ranjababu
authors.initials: R
authors.lastname: Kulasegaram
authors.forename: Frances M K
authors.initials: FM
authors.lastname: Williams
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology*; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires