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Osteoporosis and fractures in HIV/hepatitis C virus coinfection: a systematic review and meta-analysis

Dong, Huan V.a; Cortés, Yamnia I.b; Shiau, Stephaniec,d; Yin, Michael T.e

doi: 10.1097/QAD.0000000000000363
Epidemiology and Social

Objective: There is growing evidence that fracture risk is increased in individuals with HIV and/or hepatitis C virus (HCV) infection. We systematically reviewed the literature to determine whether prevalence of osteoporosis and incidence of fracture is increased in HIV/HCV-coinfected individuals.

Design: A systematic review and meta-analysis.

Methods: A search was performed of Medline, Scopus and the Cochrane Library databases, as well as of abstracts from annual retroviral, liver and bone meetings (up to 2013) for studies with bone mineral density (BMD) or bone fracture data for HIV/HCV-coinfected individuals. Osteoporosis odds ratios (ORs) and fracture incidence rate ratios (IRRs) were estimated from studies with data on HIV-monoinfected or HIV/HCV-uninfected comparison groups.

Results: Of 15 included studies, nine reported BMD data and six reported fracture data. For HIV/HCV-coinfected, the estimated osteoporosis prevalence was 22% [95% confidence interval (95% CI) 12–31] and the crude OR for osteoporosis compared with HIV-monoinfected was 1.63 (95% CI 1.27–2.11). The pooled IRR of overall fracture risk for HIV/HCV-coinfected individuals was 1.77 (95% CI 1.44–2.18) compared with HIV-monoinfected and 2.95 (95% CI 2.17–4.01) compared with uninfected individuals. In addition to HIV/HCV-coinfection, older age, lower BMI, smoking, alcohol and substance use were significant predictors of osteoporosis and fractures across studies.

Conclusion: HIV/HCV coinfection is associated with a greater risk of osteoporosis and fracture than HIV monoinfection; fracture risk is even greater than uninfected controls. These data suggest that HIV/HCV-coinfected individuals should be targeted for fracture prevention through risk factor modification at all ages and DXA screening at age 50.

aInstitute of Human Nutrition

bSchool of Nursing

cGertrude H. Sergievsky Center

dDepartment of Epidemiology

eDepartment of Medicine, Division of Infectious Diseases, Columbia University Medical Center, New York, New York, USA.

Correspondence to Michael T. Yin, MD, MS, Division of Infectious Diseases, Columbia University Medical Center, 6530 West 168th Street, PH 8-876, New York, NY 10032, USA. Tel: +1 212 305 7185; fax: +1 212 305 7290; E-mail:

Received 7 April, 2014

Revised 22 May, 2014

Accepted 23 May, 2014

© 2014 Lippincott Williams & Wilkins, Inc.