Risk of fracture is significantly higher in HIV-infected patients

As antiviral treatment for HIV infection allows patients to live longer, many will be confronted with additional health challenges. A new study shows for the first time that one of these may be significantly increased risk of bone fractures.

The report in the September Journal of Clinical Endocrinology and Metabolism finds that fracture prevalence was increased more than 60 percent in those infected with HIV compared to patients without HIV infection.

“This is the largest investigation to date to compare fracture rates in HIV-infected patients with those of non-infected controls,” says Steven Grinspoon, MD, of the Massachusetts General Hospital (MGH) Neuroendocrine Unit and Program in Nutritional Metabolism, the report's senior author. “This very large study group – with more than 8,500 HIV-infected patients and over two million controls – has the power to detect significant differences in risk for both men and women at critical sites such as the hip and spine, risks that increased with age.”

Previous studies of the impact of HIV on bone health focused on bone density and reported increased prevalence of osteoporosis and the less-serious condition osteopenia in HIV-infected men and women, but evaluation of the consequences of these conditions was limited. For the current study, the investigators utilized the Partners HealthCare System Research Patient Data Registry, which includes demographic and diagnostic information on patients treated at MGH and Brigham and Women's Hospital.

Their analysis of data from patients treated over an 11-year period revealed that almost 2.9 percent of HIV patients were diagnosed with fractures of the hip, spine or wrist, while fracture prevalence was only 1.8 percent in non-HIV-infected patients. HIV-associated increases in fracture rates were seen in both men – 3 percent versus 1.8 percent – and women – 2.5 percent versus 1.7 percent; and the increased risk was even more pronounced in older patients.

“These data indicate that we should screen HIV-infected patients, both men and women, for low bone density as they age.” Grinspoon says. “We also need to learn more about the mechanisms of this bone loss – whether antiviral drugs, the virus itself, or other metabolic factors are responsible – and investigate specific fracture rates for women before and after menopause.” Grinspoon is a professor of Medicine at Harvard Medical School.