title: Increased Fracture Incidence in Middle-Aged HIV-Infected and HIV-Uninfected Women: Updated Results From the Women's Interagency HIV Study.
abstract: BACKGROUND
  We previously reported that fracture incidence rates did not differ by HIV status among predominantly premenopausal Women's Interagency HIV Study participants. We now conduct a follow-up study with 5 additional observation years to further characterize fracture risk associated with HIV infection in women as they age.
  
  
  METHODS
  We measured time to first new fracture at any site in 2375 (1713 HIV-infected and 662 HIV-uninfected) Women's Interagency HIV Study participants, with median 10-year follow-up. Fractures were self-reported semiannually. Proportional hazards models assessed predictors of incident fracture.
  
  
  RESULTS
  At index visit, HIV-infected women were older [median age of 40 years (IQR: 34-46) vs. 35 (27-43), P < 0.0001] and more likely to be postmenopausal, hepatitis C virus infected, and weigh less than HIV-uninfected women. Among HIV-infected women, mean CD4 count was 480 cells per microliter and 63% were taking highly active antiretroviral therapy. Unadjusted incidence rates of any fracture were higher in HIV-infected than in HIV-uninfected women [2.19/100 person-years (py) vs. 1.54/100 py, P = 0.002]. In multivariate models, HIV status, older age, white (vs. black) race, prior fracture, history of cocaine use, and history of injection drug use were significant predictors of incident fracture. Among HIV-infected women, age, white race, prior fracture, smoking, and prior AIDS were predictors of new fracture.
  
  
  CONCLUSIONS
  Middle-aged HIV-infected women had a higher adjusted fracture rate than HIV-uninfected women. Cocaine use and injection drug use were also associated with a greater risk of incident fracture. Further research is needed to understand whether the risk of fracture associated with cocaine use relates to increased rate of falls or direct effects on bone metabolism.
authors: *Department of Medicine, Albert Einstein College of Medicine, Bronx, NY; †Department of Epidemiology and Community Health, New York Medical College, Valhalla, NY; ‡Department of Statistics and Biostatistics, Rutgers University, Piscataway, NJ; §Division of Infectious Diseases, University of California at San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, CA; ‖Department of Medicine, Georgetown University School of Medicine, Washington, DC; ¶Department of Medicine, Stroger (formerly Cook County) Hospital and Rush University, Chicago, IL; #Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; **Department of Neurology, State University of New York Downstate Medical Center, Brooklyn, NY; and ††Division of Infectious Diseases, Columbia University Medical Center, New York, NY.
authors: Anjali
authors: A
authors: Sharma
authors: Qiuhu
authors: Q
authors: Shi
authors: Donald R
authors: DR
authors: Hoover
authors: Kathryn
authors: K
authors: Anastos
authors: Phyllis C
authors: PC
authors: Tien
authors: Mary A
authors: MA
authors: Young
authors: Mardge H
authors: MH
authors: Cohen
authors: Elizabeth T
authors: ET
authors: Golub
authors: Deborah
authors: D
authors: Gustafson
authors: Michael T
authors: MT
authors: Yin
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology*; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors