Increased fracture incidence in middle-aged HIV-infected and HIV-uninfected women

Updated results from the women's interagency HIV study

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

Research output: Contribution to journalArticle

Abstract

Background: We previously reported that fracture incidence rates did not differ by HIV status among predominantly premenopausal Women's Interagency HIV Study participants. We now conduct a follow-up study with 5 additional observation years to further characterize fracture risk associated with HIV infection in women as they age. Methods: We measured time to first new fracture at any site in 2375 (1713 HIV-infected and 662 HIV-uninfected) Women's Interagency HIV Study participants, with median 10-year follow-up. Fractures were self-reported semiannually. Proportional hazards models assessed predictors of incident fracture. Results: At index visit, HIV-infected women were older [median age of 40 years (IQR: 34-46) vs. 35 (27-43), P <0.0001] and more likely to be postmenopausal, hepatitis C virus infected, and weigh less than HIV-uninfected women. Among HIV-infected women, mean CD4 + count was 480 cells per microliter and 63% were taking highly active antiretroviral therapy. Unadjusted incidence rates of any fracture were higher in HIV-infected than in HIV-uninfected women [2.19/100 person-years (py) vs. 1.54/100 py, P 0.002]. In multivariate models, HIV status, older age, white (vs. black) race, prior fracture, history of cocaine use, and history of injection drug use were significant predictors of incident fracture. Among HIV-infected women, age, white race, prior fracture, smoking, and prior AIDS were predictors of new fracture. Conclusions: Middle-aged HIV-infected women had a higher adjusted fracture rate than HIV-uninfected women. Cocaine use and injection drug use were also associated with a greater risk of incident fracture. Further research is needed to understand whether the risk of fracture associated with cocaine use relates to increased rate of falls or direct effects on bone metabolism.

Original languageEnglish (US)
Pages (from-to)54-61
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume70
Issue number1
DOIs
StatePublished - Sep 1 2015

Fingerprint

HIV
Incidence
Cocaine
Injections
Highly Active Antiretroviral Therapy
CD4 Lymphocyte Count
Proportional Hazards Models
Hepacivirus
Pharmaceutical Preparations
HIV Infections
Acquired Immunodeficiency Syndrome
Smoking
Observation
Bone and Bones

Keywords

  • bone
  • fracture
  • fragility fracture
  • HIV
  • women

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Increased fracture incidence in middle-aged HIV-infected and HIV-uninfected women : Updated results from the women's interagency HIV study. / Sharma, Anjali; Shi, Qiuhu; Hoover, Donald R.; Anastos, Kathryn; Tien, Phyllis C.; Young, Mary A.; Cohen, Mardge H.; Golub, Elizabeth; Gustafson, Deborah; Yin, Michael T.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 70, No. 1, 01.09.2015, p. 54-61.

Research output: Contribution to journalArticle

Sharma, Anjali ; Shi, Qiuhu ; Hoover, Donald R. ; Anastos, Kathryn ; Tien, Phyllis C. ; Young, Mary A. ; Cohen, Mardge H. ; Golub, Elizabeth ; Gustafson, Deborah ; Yin, Michael T. / Increased fracture incidence in middle-aged HIV-infected and HIV-uninfected women : Updated results from the women's interagency HIV study. In: Journal of Acquired Immune Deficiency Syndromes. 2015 ; Vol. 70, No. 1. pp. 54-61.
@article{d8ffc0976355467987ef13de94261292,
title = "Increased fracture incidence in middle-aged HIV-infected and HIV-uninfected women: Updated results from the women's interagency HIV study",
abstract = "Background: We previously reported that fracture incidence rates did not differ by HIV status among predominantly premenopausal Women's Interagency HIV Study participants. We now conduct a follow-up study with 5 additional observation years to further characterize fracture risk associated with HIV infection in women as they age. Methods: We measured time to first new fracture at any site in 2375 (1713 HIV-infected and 662 HIV-uninfected) Women's Interagency HIV Study participants, with median 10-year follow-up. Fractures were self-reported semiannually. Proportional hazards models assessed predictors of incident fracture. Results: At index visit, HIV-infected women were older [median age of 40 years (IQR: 34-46) vs. 35 (27-43), P <0.0001] and more likely to be postmenopausal, hepatitis C virus infected, and weigh less than HIV-uninfected women. Among HIV-infected women, mean CD4 + count was 480 cells per microliter and 63{\%} were taking highly active antiretroviral therapy. Unadjusted incidence rates of any fracture were higher in HIV-infected than in HIV-uninfected women [2.19/100 person-years (py) vs. 1.54/100 py, P 0.002]. In multivariate models, HIV status, older age, white (vs. black) race, prior fracture, history of cocaine use, and history of injection drug use were significant predictors of incident fracture. Among HIV-infected women, age, white race, prior fracture, smoking, and prior AIDS were predictors of new fracture. Conclusions: Middle-aged HIV-infected women had a higher adjusted fracture rate than HIV-uninfected women. Cocaine use and injection drug use were also associated with a greater risk of incident fracture. Further research is needed to understand whether the risk of fracture associated with cocaine use relates to increased rate of falls or direct effects on bone metabolism.",
keywords = "bone, fracture, fragility fracture, HIV, women",
author = "Anjali Sharma and Qiuhu Shi and Hoover, {Donald R.} and Kathryn Anastos and Tien, {Phyllis C.} and Young, {Mary A.} and Cohen, {Mardge H.} and Elizabeth Golub and Deborah Gustafson and Yin, {Michael T.}",
year = "2015",
month = "9",
day = "1",
doi = "10.1097/QAI.0000000000000674",
language = "English (US)",
volume = "70",
pages = "54--61",
journal = "Journal of Acquired Immune Deficiency Syndromes",
issn = "1525-4135",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Increased fracture incidence in middle-aged HIV-infected and HIV-uninfected women

T2 - Updated results from the women's interagency HIV study

AU - Sharma, Anjali

AU - Shi, Qiuhu

AU - Hoover, Donald R.

AU - Anastos, Kathryn

AU - Tien, Phyllis C.

AU - Young, Mary A.

AU - Cohen, Mardge H.

AU - Golub, Elizabeth

AU - Gustafson, Deborah

AU - Yin, Michael T.

PY - 2015/9/1

Y1 - 2015/9/1

N2 - Background: We previously reported that fracture incidence rates did not differ by HIV status among predominantly premenopausal Women's Interagency HIV Study participants. We now conduct a follow-up study with 5 additional observation years to further characterize fracture risk associated with HIV infection in women as they age. Methods: We measured time to first new fracture at any site in 2375 (1713 HIV-infected and 662 HIV-uninfected) Women's Interagency HIV Study participants, with median 10-year follow-up. Fractures were self-reported semiannually. Proportional hazards models assessed predictors of incident fracture. Results: At index visit, HIV-infected women were older [median age of 40 years (IQR: 34-46) vs. 35 (27-43), P <0.0001] and more likely to be postmenopausal, hepatitis C virus infected, and weigh less than HIV-uninfected women. Among HIV-infected women, mean CD4 + count was 480 cells per microliter and 63% were taking highly active antiretroviral therapy. Unadjusted incidence rates of any fracture were higher in HIV-infected than in HIV-uninfected women [2.19/100 person-years (py) vs. 1.54/100 py, P 0.002]. In multivariate models, HIV status, older age, white (vs. black) race, prior fracture, history of cocaine use, and history of injection drug use were significant predictors of incident fracture. Among HIV-infected women, age, white race, prior fracture, smoking, and prior AIDS were predictors of new fracture. Conclusions: Middle-aged HIV-infected women had a higher adjusted fracture rate than HIV-uninfected women. Cocaine use and injection drug use were also associated with a greater risk of incident fracture. Further research is needed to understand whether the risk of fracture associated with cocaine use relates to increased rate of falls or direct effects on bone metabolism.

AB - Background: We previously reported that fracture incidence rates did not differ by HIV status among predominantly premenopausal Women's Interagency HIV Study participants. We now conduct a follow-up study with 5 additional observation years to further characterize fracture risk associated with HIV infection in women as they age. Methods: We measured time to first new fracture at any site in 2375 (1713 HIV-infected and 662 HIV-uninfected) Women's Interagency HIV Study participants, with median 10-year follow-up. Fractures were self-reported semiannually. Proportional hazards models assessed predictors of incident fracture. Results: At index visit, HIV-infected women were older [median age of 40 years (IQR: 34-46) vs. 35 (27-43), P <0.0001] and more likely to be postmenopausal, hepatitis C virus infected, and weigh less than HIV-uninfected women. Among HIV-infected women, mean CD4 + count was 480 cells per microliter and 63% were taking highly active antiretroviral therapy. Unadjusted incidence rates of any fracture were higher in HIV-infected than in HIV-uninfected women [2.19/100 person-years (py) vs. 1.54/100 py, P 0.002]. In multivariate models, HIV status, older age, white (vs. black) race, prior fracture, history of cocaine use, and history of injection drug use were significant predictors of incident fracture. Among HIV-infected women, age, white race, prior fracture, smoking, and prior AIDS were predictors of new fracture. Conclusions: Middle-aged HIV-infected women had a higher adjusted fracture rate than HIV-uninfected women. Cocaine use and injection drug use were also associated with a greater risk of incident fracture. Further research is needed to understand whether the risk of fracture associated with cocaine use relates to increased rate of falls or direct effects on bone metabolism.

KW - bone

KW - fracture

KW - fragility fracture

KW - HIV

KW - women

UR - http://www.scopus.com/inward/record.url?scp=84939813036&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84939813036&partnerID=8YFLogxK

U2 - 10.1097/QAI.0000000000000674

DO - 10.1097/QAI.0000000000000674

M3 - Article

VL - 70

SP - 54

EP - 61

JO - Journal of Acquired Immune Deficiency Syndromes

JF - Journal of Acquired Immune Deficiency Syndromes

SN - 1525-4135

IS - 1

ER -