Frailty predicts fractures among women with and at-risk for HIV

Abstract

Objective: 

To determine associations between frailty and fracture in women with and without HIV infection.

Design: 

Prospective longitudinal cohort study evaluating associations between baseline frailty status and frailty components, with first and second incident fractures.

Methods: 

We evaluated associations of frailty with fracture among 1332 women with HIV and 532 uninfected women without HIV. Frailty was defined as at least three of five Fried Frailty Index components: slow gait, reduced grip strength, exhaustion, unintentional weight loss, and low physical activity. Cox proportional hazards models determined predictors of time to first and second fracture; similar models evaluated Fried Frailty Index components.

Results: 

Women with HIV were older (median 42 vs. 39 years, P < 0.0001) and more often frail (14 vs. 8%, P = 0.04) than women without HIV; median follow-up was 10.6 years. Frailty was independently associated with time to first fracture in women with and without HIV combined [adjusted hazard ratio (aHR) 1.71, 95% confidence interval (CI): 1.30–2.26; P = 0.0001], and among women with HIV only (aHR 1.91, 95% CI: 1.41–2.58; P < 0.0001), as well as with time from first to second fracture among women with HIV (aHR 1.86, 95% CI: 1.15–3.01; P = 0.01).

Conclusion: 

In this cohort of middle-aged racial and ethnic minority women with or at-risk for HIV, frailty was a strong and independent predictor of fracture risk. As women with HIV continue to age, early frailty screening may be a useful clinical tool to help identify those at greatest risk of fracture.