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Incident fractures in HIV-infected individuals: a systematic review and meta-analysis

Shiau, Stephaniea,b; Broun, Emily C.c; Arpadi, Stephen M.a,b,d; Yin, Michael T.c

doi: 10.1097/QAD.0b013e328361d241
Epidemiology and Social

Objective(s): Some but not all studies indicate that individuals with HIV infection are at an increased risk of fracture. We systematically reviewed the literature to investigate whether incidence of fracture (both overall and fragility) differs between individuals with and without HIV.

Design: A systematic review and meta-analysis.

Methods: Medline, Scopus and the Cochrane Library databases for all studies ever published up to 28 September 2012 and electronically available conference abstracts from CROI, ASBMR, IAS and AIDS were searched. All studies reporting incidence of all fracture and fragility fracture in HIV-infected adults were included. A random effects model was used to calculate pooled estimates of incidence rate ratios (IRRs) for studies that presented data for HIV-infected and controls. For all studies, incidence rates of fracture and predictors of fracture among HIV-infected individuals were summarized.

Results: Thirteen eligible studies were analysed, of which seven included controls. Nine studies reported all incident fractures and 10 presented incident fragility fractures. The pooled IRR was 1.58 [95% confidence interval (CI) 1.25–2.00] for all fracture and 1.35 (95% CI 1.10–1.65) for fragility fracture. Smoking, white race and older age were consistent predictors for fragility fractures.

Conclusion: Our results indicate that HIV infection is associated with a modest increase in incident fracture. Future research should focus on clarifying risk factors, designing appropriate interventions and the long-term implications of this increased risk for an ageing HIV-infected population.

aGertrude H. Sergievsky Center

bDepartment of Epidemiology, Mailman School of Public Health

cDepartment of Medicine, Division of Infectious Disease

dDepartment of Pediatrics, Columbia University Medical Center, New York, New York, USA.

Correspondence to Michael T. Yin, MD, MS, Division of Infectious Diseases, Columbia University Medical Center, 630 West 168th Street, PH8-876, New York, NY 10032, USA. Tel: +1 212 305 7185; fax: +1 212 305 7290; e-mail:

Received 20 February, 2013

Revised 29 March, 2013

Accepted 2 April, 2013

© 2013 Lippincott Williams & Wilkins, Inc.