Fracture incidence in HIV-infected women

Results from the Women's Interagency HIV Study

Michael T. Yin, Qiuhu Shi, Donald R. Hoover, Kathryn Anastos, Anjali Sharma, Mary Young, Alexandra Levine, Mardge H. Cohen, Elizabeth Shane, Elizabeth Golub, Phyllis C. Tien

Research output: Contribution to journalArticle

Abstract

Background: The clinical importance of the association of HIV infection and antiretroviral therapy (ART) with low bone mineral density (BMD) in premenopausal women is uncertain because BMD stabilizes on established ART and fracture data are limited. Methods: We measured time to first new fracture at any site with median follow-up of 5.4 years in 2391 (1728 HIV-infected, 663 HIV-uninfected) participants in the Women's Interagency HIV Study (WIHS). Self-report of fracture was recorded at semiannual visits. Proportional hazard models assessed predictors of incident fracture. Results: At baseline, HIV-infected women were older (40 ± 9 vs. 36 ± 10 years, P <0.0001), more likely to report postmenopausal status and be hepatitis C virus-infected, and weighed less than HIV-uninfected women. Among HIV-infected women, mean CD4 cell count was 482 cells/μl; 66% were taking ART. Unadjusted incidence of fracture did not differ between HIV-infected and uninfected women (1.8 vs. 1.4/100 person-years, respectively, P = 0.18). In multivariate models, white (vs. African-American) race, hepatitis C virus infection, and higher serum creatinine, but not HIV serostatus, were statistically significant predictors of incident fracture. Among HIV-infected women, older age, white race, current cigarette use, and history of AIDS-defining illness were associated with incidence of new fracture. Conclusion: Among predominantly premenopausal women, there was little difference in fracture incidence rates by HIV status, rather traditional risk factors were important predictors. Further research is necessary to characterize fracture risk in HIV-infected women during and after the menopausal transition.

Original languageEnglish (US)
Pages (from-to)2679-2686
Number of pages8
JournalAIDS
Volume24
Issue number17
DOIs
StatePublished - Nov 13 2010

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HIV
Incidence
Hepacivirus
Bone Density
Virus Diseases
CD4 Lymphocyte Count
Proportional Hazards Models
Tobacco Products
African Americans
Self Report
HIV Infections
Creatinine
Acquired Immunodeficiency Syndrome
Therapeutics
Serum
Research

Keywords

  • fracture
  • fragility fracture
  • HIV-infected women
  • premenopausal

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Yin, M. T., Shi, Q., Hoover, D. R., Anastos, K., Sharma, A., Young, M., ... Tien, P. C. (2010). Fracture incidence in HIV-infected women: Results from the Women's Interagency HIV Study. AIDS, 24(17), 2679-2686. https://doi.org/10.1097/QAD.0b013e32833f6294

Fracture incidence in HIV-infected women : Results from the Women's Interagency HIV Study. / Yin, Michael T.; Shi, Qiuhu; Hoover, Donald R.; Anastos, Kathryn; Sharma, Anjali; Young, Mary; Levine, Alexandra; Cohen, Mardge H.; Shane, Elizabeth; Golub, Elizabeth; Tien, Phyllis C.

In: AIDS, Vol. 24, No. 17, 13.11.2010, p. 2679-2686.

Research output: Contribution to journalArticle

Yin, MT, Shi, Q, Hoover, DR, Anastos, K, Sharma, A, Young, M, Levine, A, Cohen, MH, Shane, E, Golub, E & Tien, PC 2010, 'Fracture incidence in HIV-infected women: Results from the Women's Interagency HIV Study', AIDS, vol. 24, no. 17, pp. 2679-2686. https://doi.org/10.1097/QAD.0b013e32833f6294
Yin MT, Shi Q, Hoover DR, Anastos K, Sharma A, Young M et al. Fracture incidence in HIV-infected women: Results from the Women's Interagency HIV Study. AIDS. 2010 Nov 13;24(17):2679-2686. https://doi.org/10.1097/QAD.0b013e32833f6294
Yin, Michael T. ; Shi, Qiuhu ; Hoover, Donald R. ; Anastos, Kathryn ; Sharma, Anjali ; Young, Mary ; Levine, Alexandra ; Cohen, Mardge H. ; Shane, Elizabeth ; Golub, Elizabeth ; Tien, Phyllis C. / Fracture incidence in HIV-infected women : Results from the Women's Interagency HIV Study. In: AIDS. 2010 ; Vol. 24, No. 17. pp. 2679-2686.
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abstract = "Background: The clinical importance of the association of HIV infection and antiretroviral therapy (ART) with low bone mineral density (BMD) in premenopausal women is uncertain because BMD stabilizes on established ART and fracture data are limited. Methods: We measured time to first new fracture at any site with median follow-up of 5.4 years in 2391 (1728 HIV-infected, 663 HIV-uninfected) participants in the Women's Interagency HIV Study (WIHS). Self-report of fracture was recorded at semiannual visits. Proportional hazard models assessed predictors of incident fracture. Results: At baseline, HIV-infected women were older (40 ± 9 vs. 36 ± 10 years, P <0.0001), more likely to report postmenopausal status and be hepatitis C virus-infected, and weighed less than HIV-uninfected women. Among HIV-infected women, mean CD4 cell count was 482 cells/μl; 66{\%} were taking ART. Unadjusted incidence of fracture did not differ between HIV-infected and uninfected women (1.8 vs. 1.4/100 person-years, respectively, P = 0.18). In multivariate models, white (vs. African-American) race, hepatitis C virus infection, and higher serum creatinine, but not HIV serostatus, were statistically significant predictors of incident fracture. Among HIV-infected women, older age, white race, current cigarette use, and history of AIDS-defining illness were associated with incidence of new fracture. Conclusion: Among predominantly premenopausal women, there was little difference in fracture incidence rates by HIV status, rather traditional risk factors were important predictors. Further research is necessary to characterize fracture risk in HIV-infected women during and after the menopausal transition.",
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AU - Yin, Michael T.

AU - Shi, Qiuhu

AU - Hoover, Donald R.

AU - Anastos, Kathryn

AU - Sharma, Anjali

AU - Young, Mary

AU - Levine, Alexandra

AU - Cohen, Mardge H.

AU - Shane, Elizabeth

AU - Golub, Elizabeth

AU - Tien, Phyllis C.

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N2 - Background: The clinical importance of the association of HIV infection and antiretroviral therapy (ART) with low bone mineral density (BMD) in premenopausal women is uncertain because BMD stabilizes on established ART and fracture data are limited. Methods: We measured time to first new fracture at any site with median follow-up of 5.4 years in 2391 (1728 HIV-infected, 663 HIV-uninfected) participants in the Women's Interagency HIV Study (WIHS). Self-report of fracture was recorded at semiannual visits. Proportional hazard models assessed predictors of incident fracture. Results: At baseline, HIV-infected women were older (40 ± 9 vs. 36 ± 10 years, P <0.0001), more likely to report postmenopausal status and be hepatitis C virus-infected, and weighed less than HIV-uninfected women. Among HIV-infected women, mean CD4 cell count was 482 cells/μl; 66% were taking ART. Unadjusted incidence of fracture did not differ between HIV-infected and uninfected women (1.8 vs. 1.4/100 person-years, respectively, P = 0.18). In multivariate models, white (vs. African-American) race, hepatitis C virus infection, and higher serum creatinine, but not HIV serostatus, were statistically significant predictors of incident fracture. Among HIV-infected women, older age, white race, current cigarette use, and history of AIDS-defining illness were associated with incidence of new fracture. Conclusion: Among predominantly premenopausal women, there was little difference in fracture incidence rates by HIV status, rather traditional risk factors were important predictors. Further research is necessary to characterize fracture risk in HIV-infected women during and after the menopausal transition.

AB - Background: The clinical importance of the association of HIV infection and antiretroviral therapy (ART) with low bone mineral density (BMD) in premenopausal women is uncertain because BMD stabilizes on established ART and fracture data are limited. Methods: We measured time to first new fracture at any site with median follow-up of 5.4 years in 2391 (1728 HIV-infected, 663 HIV-uninfected) participants in the Women's Interagency HIV Study (WIHS). Self-report of fracture was recorded at semiannual visits. Proportional hazard models assessed predictors of incident fracture. Results: At baseline, HIV-infected women were older (40 ± 9 vs. 36 ± 10 years, P <0.0001), more likely to report postmenopausal status and be hepatitis C virus-infected, and weighed less than HIV-uninfected women. Among HIV-infected women, mean CD4 cell count was 482 cells/μl; 66% were taking ART. Unadjusted incidence of fracture did not differ between HIV-infected and uninfected women (1.8 vs. 1.4/100 person-years, respectively, P = 0.18). In multivariate models, white (vs. African-American) race, hepatitis C virus infection, and higher serum creatinine, but not HIV serostatus, were statistically significant predictors of incident fracture. Among HIV-infected women, older age, white race, current cigarette use, and history of AIDS-defining illness were associated with incidence of new fracture. Conclusion: Among predominantly premenopausal women, there was little difference in fracture incidence rates by HIV status, rather traditional risk factors were important predictors. Further research is necessary to characterize fracture risk in HIV-infected women during and after the menopausal transition.

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KW - fragility fracture

KW - HIV-infected women

KW - premenopausal

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