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Incidence of low and high-energy fractures in persons with and without HIV infection: a Danish population-based cohort study

Hansen, Ann-Brit E.a; Gerstoft, Jana; Kronborg, Gitteb; Larsen, Carsten S.c; Pedersen, Courtd; Pedersen, Gittee; Obel, Nielsa

doi: 10.1097/QAD.0b013e32834ed8a7
Clinical Science

Objective: To compare fracture risk in persons with and without HIV infection and to examine the influence of highly active antiretroviral therapy (HAART) initiation on risk of fracture.

Design: Population-based nationwide cohort study using Danish registries.

Methods: Outcome measures were time to first fracture at any site, time to first low-energy and high-energy fracture in HIV-infected patients (n = 5306) compared with a general population control cohort (n = 26 530) matched by sex and age during the study period 1995–2009. Cox regression analyses were used to estimate incidence rate ratios (IRRs).

Results: HIV-infected patients had increased risk of fracture [IRR 1.5, 95% confidence interval (CI) 1.4–1.7] compared with population controls. The relative risk was lower in HIV-monoinfected patients (IRR 1.3, 95% CI 1.2–1.4) than in HIV/hepatitis C virus (HCV)-coinfected patients (IRR 2.9, 95% CI 2.5–3.4).

Both HIV-monoinfected and HIV/HCV-coinfected patients had increased risk of low-energy fracture, IRR of 1.6 (95% CI 1.4–1.8) and 3.8 (95% CI 3.0–4.9). However, only HIV/HCV-coinfected patients had increased risk of high-energy fracture, IRR of 2.4 (95% CI 2.0–2.9). Among HIV-monoinfected patients the risk of low-energy fracture was only significantly increased after HAART exposure, IRR of 1.8 (95% CI 1.5–2.1). The increased risk in HAART-exposed patients was not associated with CD4 cell count, prior AIDS, tenofovir or efavirenz exposure, but with comorbidity and smoking.

Conclusion: HIV-infected patients had increased risk of fracture compared with population controls. Among HIV-monoinfected patients the increased risk was observed for low-energy but not for high-energy fractures, and the increased risk of low-energy fracture was only observed in HAART-exposed patients.

aDepartment of Infectious Diseases, Copenhagen University Hospital Rigshospitalet

bDepartment of Infectious Diseases, Copenhagen University Hospital Hvidovre Hospital, Copenhagen

cDepartment of Infectious Diseases, Aarhus University Hospital, Skejby

dDepartment of Infectious Diseases, Odense University Hospital, Odense

eDepartment of Infectious Diseases, Aarhus University Hospital, Aalborg, Denmark.

Correspondence to Ann-Brit E. Hansen, MD, PhD, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark. E-mail: ann-brit.eg.hansen@rh.regionh.dk

Received 23 July, 2011

Revised 13 October, 2011

Accepted 3 November, 2011

© 2012 Lippincott Williams & Wilkins, Inc.