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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‡‡

JAIDS Journal of Acquired Immune Deficiency Syndromes: May 1st, 2014 - Volume 66 - Issue 1 - p 90–95
doi: 10.1097/QAI.0000000000000112
Epidemiology and Prevention

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.

*Oxford National Institute for Health Research (NIHR), Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK;

Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK;

Internal Medicine Department, Musculoskeletal Research Unit and Red Tematica de Investigacion Cooperativa en Envejecimiento y Fragilidad (RETICEF), Fundacio Institut Mar d'Investigacions Mediques (FIMIM), and Instituto de Salud Carlos III, Barcelona, Spain;

§Institut d'Investigacio en Atencio Primaria (IDIAP), Jordi Gol-Primary Care Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain;

Department of Internal Medicine and Infectious Diseases, Parc Salut Mar, Barcelona, Spain;

Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands;

#Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center, Maastricht, The Netherlands;

**Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands;

††Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands; and

‡‡Aalborg Hospital, Aalborg University, Aalborg, Denmark.

Correspondence to: Peter Vestergaard, MD, Aalborg Hospital, Aalborg University, Room C2-201, Fredrik Bajersvej 7C, DK-9220 Aalborg, Denmark (e-mail:

All the authors declare that they have no commercial or any other association that might pose a conflict of interest for the manuscript enclosed.

This study was made possible through a grant by the A.P. Møller Foundation (Fonden til Lægevidenskabens Fremme) and The Danish Medical Research Council (grant number 22-04-0495). The sponsors had no role in obtaining, analyzing, and interpreting the data. DanmarksStatistik (Statistics Denmark) is acknowledged for the help without which this project would not have been possible. D.P.A. receives partial support from the Oxford NIHR Musculoskeletal Biomedical Research Unit and IDIAP Jordi Gol. D.P.A., R.G.F., and A.D.P. received funding from RETICEF (FEDER), Instituto de Salud Carlos III, Government of Spain.

Preliminary results from this work were reported as a Plenary Poster at the last American Society of Bone and Mineral Research Annual Meeting, October 16, 2012, Minneapolis, MN.

Received January 02, 2013

Accepted January 02, 2013

© 2014 by Lippincott Williams & Wilkins