HIV- and antiretroviral therapy–induced bone loss has long been recognized, but only recently have we begun to appreciate its effect on fracture risk. In a recent case-control study conducted to explore this association, researchers used Danish National Health Service registries data on patients with fractures in 2000 and age- and sex-matched controls without fractures that year (n=124,655 and 373,962, respectively).
After adjustment for traditional osteoporosis risks, HIV infection was associated with a significantly increased fracture risk (odds ratio, 2.00). This association was particularly strong at key fracture-prone sites, including the hip (OR, 6.46), the spine (OR, 4.65), and the forearm (OR, 2.34). The findings were similar between men and women and between younger and middle-aged populations. Risk was related to the duration of infection, rising most rapidly during the first 2 or 3 years following HIV diagnosis and more slowly thereafter.
Dr. Ofotokun is an associate professor of infectious disease, Emory University School of Medicine, and an investigator for the Atlanta Clinical & Translational Science Institute, Emory University. He reports no conflicts of interest.
Prieto-Alhambra D et al. HIV infection and its association with an excess risk of clinical fractures: A nationwide case–control study. J Acquir Immune Defic Syndr 2014 May 1; 66:90.