HIV infection and its association with an excess risk of clinical fractures: a nationwide case-control study.
BACKGROUND
Different studies have reported an association between HIV infection, antiretroviral therapies, and impaired bone metabolism, but data on their impact on fracture risk are scarce. We studied the association between a clinical diagnosis of HIV infection and fracture risk.


METHODS
We conducted a case-control study using data from the Danish National Health Service registries, including 124,655 fracture cases and 373,962 age- and gender-matched controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression.


RESULTS
A total of 50 (0.40/1000) patients in the fracture group and 52 (0.14/1000) controls had an HIV diagnosis. The risk of any fracture was thus significantly increased among HIV-infected patients (age- and gender-matched OR = 2.89, 95% CI: 1.99 to 4.18). Similarly, significant increases in the risk of hip (OR = 8.99, 95% CI: 1.39 to 58.0), forearm (OR = 3.50, 95% CI: 1.26 to 9.72), and spine fractures (OR = 9.00, 95% CI: 1.39 to 58.1) were observed.


CONCLUSIONS
HIV infection is associated with an almost 3-fold increase in fracture risk compared with that of age- and gender-matched uninfected patients. HIV patients are also at an almost 9-fold higher risk of hip fracture.
*Oxford National Institute for Health Research (NIHR), Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; †Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; ‡Internal Medicine Department, Musculoskeletal Research Unit and Red Tematica de Investigacion Cooperativa en Envejecimiento y Fragilidad (RETICEF), Fundacio Institut Mar d'Investigacions Mediques (FIMIM), and Instituto de Salud Carlos III, Barcelona, Spain; §Institut d'Investigacio en Atencio Primaria (IDIAP), Jordi Gol-Primary Care Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; ‖Department of Internal Medicine and Infectious Diseases, Parc Salut Mar, Barcelona, Spain; ¶Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands; #Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center, Maastricht, The Netherlands; **Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands; ††Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands; and ‡‡Aalborg Hospital, Aalborg University, Aalborg, Denmark.
Daniel
D
Prieto-Alhambra
Robert
R
Güerri-Fernández
Frank
F
De Vries
Arief
A
Lalmohamed
Marloes
M
Bazelier
Jakob
J
Starup-Linde
Adolfo
A
Diez-Perez
Cyrus
C
Cooper
Peter
P
Vestergaard
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003718:Denmark / Q000453:epidemiology; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D055815:Young Adult