HIV Boosted Bone Fracture Risk

HIV patients found to have higher risk of fractures and bone disease

/ Author:  / Reviewed by: Beth Bolt, RPh Joseph V. Madia, MD

(RxWiki News) HIV/AIDS treatment has helped lengthen patients' lives. But as they live longer, people with HIV may have to be especially watchful for health problems related to age, including the possibility of weaker bones.

A recent study found that people with HIV had higher odds of having a bone fracture than people without HIV.

The researchers therefore believe that HIV patients may be more at risk for developing osteoporosis — a bone disease where the bones become fragile due to decreased bone mass.

"Talk to your doctor to determine if you should be tested for HIV."

The lead author of this study was Barry S. Peters, MD, from the Department of Infectious Diseases at Kings College London and Honorary Consultant Physician at Guy's and St. Thomas' Foundation Hospitals in London, England.

The study population included 222 HIV patients who regularly visited the HIV outpatient clinic at Guy's and St. Thomas' Hospitals between January 2009 and April 2010.

Of the participants, 60 percent were male, 48 percent were Caucasian, 4 percent were Asian, 38 percent were African, and 10 percent were other non-specifically reported races.

The average age of the participants was 45.6, and the average time since diagnosis was seven years.

A total of 85 percent of the patients were taking a type of HIV treatment called highly active anti-retroviral therapy (HAART).

The study also included a group of 222 controls who did not have HIV and were matched for age and parental history of hip fracture.

Bone mineral density (BMD) is the measurement of bone mass.

The researchers gave both the participants and controls questionnaires asking about various risk factors for fragility fracture, including age, sex, weight, height, previous fracture, current smoking, parent hip fracture, alcohol use, secondary osteoporosis (decreased BMD caused by an outside chronic condition) and current glucocorticoid use (medication to decrease inflammation in an overactive immune system), as well as HIV-related history.

While 45 patients (20.3 percent) in the HIV group reported at least one previous fracture, 16 (7.2 percent) of the controls reported a previous fracture.

The researchers determined that the HIV group had 3.27 times the odds of having had a previous fracture compared to the controls.

The HIV group also had a significantly lower body mass index (height to weight ratio) and higher alcohol use than the control group.

The findings also showed that 18 percent of the HIV group had osteoporosis, compared to 4 percent of the controls. Of the HIV patients who were 55 and older, 58 percent of the women had osteoporosis versus 8 percent of men.

In addition, 43 percent of the HIV group had osteopenia (decreased BMD but not as severe as osteoporosis), compared to 29 percent of the controls.

In general, the participants and controls with osteoporosis were older than the people with normal BMD or osteopenia.

A similar number of HIV-positive women and men under 45 years old were found to have low BMD, with 62 percent of women versus 58 percent of men having low BMD.

However, in the HIV patients over 49 years old, 73 percent of women had low BMD, compared to 64 percent of men.

The researchers also discovered that HAART use was a significant fracture risk factor, as it was associated with low BMD. Overall, the patients using HAART were found to have 3.6 times greater odds of having low BMD.

The findings also revealed that patients with a higher body mass index had 10 percent lower odds of having low BMD; and patients with higher testosterone levels had 1.04 times the odds of having low BMD.

Gender, age and alcohol use were also found to slightly increase the odds of having low BMD.

The authors noted a few limitations of their study.

First, the control group had a smaller number of young people, and significantly fewer males, than the HIV group. Second, there was not enough information for the researchers to tell the difference between fractures due to fragility or trauma. Third, most of the control group was Caucasian compared to the HIV group, which was more ethnically diverse.

This study was published online ahead-of-print on October 29 in PLOS One.

GlaxoSmithKline pharmaceuticals and ViiV pharmaceuticals provided funding.

Review Date: 
October 31, 2013
Last Updated:
December 31, 2013