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JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0000000000000112
Epidemiology and Prevention

HIV Infection and Its Association With an Excess Risk of Clinical Fractures: A Nationwide Case–Control Study

Prieto-Alhambra, Daniel MSc, PhD*,†,‡,§; Güerri-Fernández, Robert MD, PhD‡,‖; De Vries, Frank PhD, PharmD†,¶,#,**; Lalmohamed, Arief MSc**,††; Bazelier, Marloes PhD**; Starup-Linde, Jakob MD‡‡; Diez-Perez, Adolfo MD, PhD‡,‖; Cooper, Cyrus MA, DM, FRCP, FFPH, FMedSci*,†; Vestergaard, Peter MD, Prof‡‡

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Abstract

Background: Different studies have reported an association between HIV infection, antiretroviral therapies, and impaired bone metabolism, but data on their impact on fracture risk are scarce. We studied the association between a clinical diagnosis of HIV infection and fracture risk.

Methods: We conducted a case–control study using data from the Danish National Health Service registries, including 124,655 fracture cases and 373,962 age- and gender-matched controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression.

Results: A total of 50 (0.40/1000) patients in the fracture group and 52 (0.14/1000) controls had an HIV diagnosis. The risk of any fracture was thus significantly increased among HIV-infected patients (age- and gender-matched OR = 2.89, 95% CI: 1.99 to 4.18). Similarly, significant increases in the risk of hip (OR = 8.99, 95% CI: 1.39 to 58.0), forearm (OR = 3.50, 95% CI: 1.26 to 9.72), and spine fractures (OR = 9.00, 95% CI: 1.39 to 58.1) were observed.

Conclusions: HIV infection is associated with an almost 3-fold increase in fracture risk compared with that of age- and gender-matched uninfected patients. HIV patients are also at an almost 9-fold higher risk of hip fracture.

© 2014 by Lippincott Williams & Wilkins

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