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01-12-2021 | Human Immunodeficiency Virus | Original Article

Incident bone fracture and mortality in a large HIV cohort outpatient study, 2000–2017, USA

Authors: Linda Battalora, Carl Armon, Frank Palella, Jun Li, Edgar T. Overton, John Hammer, Jack Fuhrer, Richard M. Novak, Kimberly Carlson, John R. Spear, Kate Buchacz, for the HIV Outpatient Study (HOPS)

Published in: Archives of Osteoporosis | Issue 1/2021

Abstract

Summary

We evaluated the association of bone fracture with mortality among persons with HIV, controlling for sociodemographic, behavioral, and clinical factors. Incident fracture was associated with 48% greater risk of all-cause mortality, underscoring the need for bone mineral density screening and fracture prevention.

Purpose/Introduction

Low bone mineral density (BMD) and fracture are more common among persons with HIV (PWH) than those without HIV infection. We evaluated the association of bone fracture with mortality among PWH, controlling for sociodemographic, behavioral, and clinical factors.

Methods

We analyzed data from HIV Outpatient Study (HOPS) participants seen at nine US HIV clinics during January 1, 2000, through September 30, 2017. Incident fracture rates and post-fracture mortality were compared across four calendar periods. Cox proportional hazards analyses determined factors associated with all-cause mortality among all participants and those with incident fracture.

Results

Among 6763 HOPS participants, 504 (7.5%) had incident fracture (median age = 47 years) and 719 (10.6%) died. Of fractures, 135 (26.8%) were major osteoporotic (hip/pelvis, wrist, spine, arm/shoulder). During observation, 27 participants with major osteoporotic fractures died (crude mortality 2.97/100 person-years [PY]), and 48 with other site fractures died (crude mortality 2.51/100 PY). Post-fracture, age- and sex-adjusted all-cause mortality rates per 100 PY decreased from 8.5 during 2000–2004 to 1.9 during 2013–2017 (P<0.001 for trend). In multivariable analysis, incident fracture was significantly associated with all-cause mortality (Hazard Ratio 1.48, 95% confidence interval 1.15–1.91). Among 504 participants followed post-fracture, pulmonary, kidney, and cardiovascular disease, hepatitis C virus co-infection, and non-AIDS cancer, remained independently associated with all-cause mortality.

Conclusions

Incident fracture was associated with 48% greater risk of all-cause mortality among US PWH in care, underscoring the need for BMD screening and fracture prevention. Although fracture rates among PWH increased during follow-up, post-fracture death rates decreased, likely reflecting advances in HIV care.

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Title: Incident bone fracture and mortality in a large HIV cohort outpatient study, 2000–2017, USA
Authors: Linda Battalora
Carl Armon
Frank Palella
Jun Li
Edgar T. Overton
John Hammer
Jack Fuhrer
Richard M. Novak
Kimberly Carlson
John R. Spear
Kate Buchacz
for the HIV Outpatient Study (HOPS)
Publication date: 01-12-2021
Publisher: Springer London
Keywords: Human Immunodeficiency Virus
Hepatitis C
Published in: Archives of Osteoporosis / Issue 1/2021
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-021-00949-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Incident bone fracture and mortality in a large HIV cohort outpatient study, 2000–2017, USA

Abstract

Summary

Purpose/Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Summary

Purpose/Introduction

Methods

Results

Conclusions

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