Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: A growing body of evidence suggests that HIV-positive patients have an increased risk of osteoporosis compared to HIV-negative patients, with some studies suggesting a higher risk of fracture as well. Antiretroviral therapy (ART) is thought to contribute to this increased risk as certain therapies are linked to decreased bone mineral density, but the etiology of the higher risk of osteoporosis in HIV-positive patients is likely multifactorial. Expert recommendations suggest screening for osteoporosis in HIV-positive patients starting at age 50, in both men and women. However there is a insufficient evidence as to whether HIV-infected men have fracture rates similar to HIV-infected women.
Methods: We identified HIV-positive adult patients who had been prescribed ART and were seen at least annually at two large tertiary hospitals. An institutional electronic patient registry was used to identify these patients, as well as to identify the outcome of interest – fracture at any site – indicated by diagnosis code or the patient problem list. We reviewed 50 medical records of patients identified by the patient registry as having fracture in order to assess the positive predictive value (PPV) of the algorithm for identifying fracture in the registry database. We estimated the IR per 1,000 person-years for fractures for the entire cohort as well as the IR for fractures occurring at sites associated with osteoporosis (hip, wrist, vertebrae) and the IR for all other fractures. IR of fracture was then calculated stratified by age and gender. As well, IR ratios between men and women were calculated.
Results: We identified a cohort of 3,182 HIV-positive patients prescribed ART (883 women and 2,299 men) with a total of 15,317 person-years of follow-up. 696 total fractures were found in this population. The PPV of a fracture identified in the electronic patient registry was 90% (95% CI 78-97%) as compared with medical record review. The IR of fractures occurring at osteoporotic sites among men of all ages was 15.9 (95% CI 13.6 – 18.4) compared with women which was 12.2 (95% CI 9.1-15.9), giving an incidence rate ratio of 1.3 (95% CI 0.95 – 1.80) (see Table). Men had similar or higher incidence rates of fractures at osteoporotic sites than women across most age groups until age 66, when women had higher rates, although this difference was not statistically significant. In addition, IR of fracture at all other sites were similar in men (IR 29.4, 95% CI 26.4 – 32.8) and women (IR 33.6, 95% CI 28.4 -39.4), with IR ratio of 0.88 (95% CI 0.72-1.07).
Conclusion: Fractures in HIV-positive patients on ART occur at similar rates in men and women. Recent expert recommendations suggest screening all HIV patients for osteoporosis including men. Our data offer support for this recommendation and can be used to further refine evidence-based recommendations for osteoporosis screening in HIV.
|
|
Men, Number of fractures |
Men, IR of fracture/1000 person-years [95% CI] |
Women, Number of fractures |
Women, IR of fracture/1000 person-years [95% CI] |
Incidence rate ratio (men/women) [95% CI] |
|
All fractures, all age groups |
|||||
|
|
497 |
45.3 [41.4 – 49.4 ] |
199 |
45.8 [ 39.8 – 52.4] |
0.99 [0.84 – 1.17] |
|
Fractures occurring at osteoporotic sites (hip/femur, wrist/forearm, vertebral/spine) |
|||||
|
All age groups |
174 |
15.9 [13.6 – 18.4] |
53 |
12.2 [9.1 – 15.9] |
1.30 [0.95 – 1.80] |
|
Age ≤ 35 |
16 |
15.4 [8.8 – 24.9] |
8 |
9.1 [3.9 – 17.8] |
1.70 [0.69 – 4.60] |
|
Age 36-45 |
48 |
11.8 [8.7 – 15.6] |
12 |
7.1 [3.7 – 12.4] |
1.66 [0.87 – 3.43] |
|
Age 46-55 |
64 |
16.0 [12.3 – 20.3] |
22 |
16.4 [10.3 – 24.7] |
0.97 [0.59 – 1.66] |
|
Age 56-65 |
35 |
23.0 [16.1 – 31.9] |
7 |
20.6 [8.3 – 42.1] |
1.12 [0.49 – 2.99] |
|
Age ≥66 |
11 |
34.0 [17.1 – 60.0] |
4 |
44.2[14.8 – 105.0] |
0.77 [0.23 – 3.31] |
|
Fractures occurring at all other sites (all other fracture sites) |
|||||
|
All age groups |
323 |
29.4 [26.4 – 32.8] |
146 |
33.6 [28.4 – 39.4] |
0.88 [0.72 – 1.07] |
|
Age ≤ 35 |
18 |
17.4 [10.3 – 27.3] |
29 |
32.9 [22.1 – 46.9] |
0.53 [0.28 – 0.98] |
|
Age 36-45 |
100 |
24.5 [20.0 – 29.7] |
42 |
24.8 [17.9 – 33.4] |
0.99 [0.68 – 1.45] |
|
Age 46-55 |
144 |
35.9 [30.3 – 42.1] |
58 |
43.2 [33.0 – 55.5] |
0.83 [0.61 – 1.15] |
|
Age 56-65 |
47 |
30.9 [22.8 – 40.9] |
11 |
32.4 [16.3 – 57.3] |
0.95 [0.49 – 2.04] |
|
Age ≥66 |
14 |
43.2 [23.6 – 72.5] |
6 |
66.2 [24.3 – 144.1] |
0.65 [0.24 – 2.07] |
Disclosure:
L. Gedmintas,
None;
E. Wright,
None;
J. N. Katz,
None;
E. Losina,
None;
D. H. Solomon,
Amgen & Lilly,
2,
Corrona,
5,
UptoDate,
7.
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