title: Low bone mineral density and risk of incident fracture in HIV-infected adults.
abstract: BACKGROUND
  Prevalence rates of low bone mineral density (BMD) and bone fractures are higher among HIV-infected adults compared with the general United States (US) population, but the relationship between BMD and incident fractures in HIV-infected persons has not been well described.
  
  
  METHODS
  Dual energy X-ray absorptiometry (DXA) results of the femoral neck of the hip and clinical data were obtained prospectively during 2004-2012 from participants in two HIV cohort studies. Low BMD was defined by a T-score in the interval >-2.5 to <-1.0 (osteopenia) or ≤-2.5 (osteoporosis). We analysed the association of low BMD with risk of subsequent incident fractures, adjusted for sociodemographics, other risk factors and covariables, using multivariable proportional hazards regression.
  
  
  RESULTS
  Among 1,006 participants analysed (median age 43 years [IQR 36-49], 83% male, 67% non-Hispanic white, median CD4(+) T-cell count 461 cells/mm(3) [IQR 311-658]), 36% (n=358) had osteopenia and 4% (n=37) osteoporosis; 67 had a prior fracture documented. During 4,068 person-years of observation after DXA scanning, 85 incident fractures occurred, predominantly rib/sternum (n=18), hand (n=14), foot (n=13) and wrist (n=11). In multivariable analyses, osteoporosis (adjusted hazard ratio [aHR] 4.02, 95% CI 2.02, 8.01) and current/prior tobacco use (aHR 1.59, 95% CI 1.02, 2.50) were associated with incident fracture.
  
  
  CONCLUSIONS
  In this large sample of HIV-infected adults in the US, low baseline BMD was significantly associated with elevated risk of incident fracture. There is potential value of DXA screening in this population.
authors.affiliation: Colorado School of Mines, Golden, CO, USA. LBattalo@mines.edu.
authors.forename: Linda
authors.initials: L
authors.lastname: Battalora
authors.forename: Kate
authors.initials: K
authors.lastname: Buchacz
authors.forename: Carl
authors.initials: C
authors.lastname: Armon
authors.forename: Edgar T
authors.initials: ET
authors.lastname: Overton
authors.forename: John
authors.initials: J
authors.lastname: Hammer
authors.forename: Pragna
authors.initials: P
authors.lastname: Patel
authors.forename: Joan S
authors.initials: JS
authors.lastname: Chmiel
authors.forename: Kathy
authors.initials: K
authors.lastname: Wood
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Bush
authors.forename: John R
authors.initials: JR
authors.lastname: Spear
authors.forename: John T
authors.initials: JT
authors.lastname: Brooks
authors.forename: Benjamin
authors.initials: B
authors.lastname: Young
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000328:Adult; D015519:Bone Density; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D015995:Prevalence; D012306:Risk; D014481:United States / Q000453:epidemiology