Comparative Risk of Fracture in Men and Women with HIV

Abstract

Men and women with HIV have an increased risk of fracture compared with individuals without HIV; however, it is unknown if women with HIV fracture at higher rates than men. We aimed to compare the incidence rates (IR) of fractures between men and women with HIV. The study was designed as a cohort study, examining medical records from November 2001 to August 2012. The study was performed using records from two tertiary-care hospitals in Boston, Massachusetts. The study patients were adults with HIV: this was defined by diagnosis codes for HIV on two visits, at least one prescription for antiretroviral therapy, and at least 18 years of age. IRs per 1000 person-years of all fractures and fractures at osteoporotic sites were calculated. We calculated IRs within age and gender strata and estimated IR ratios (IRR) between men and women. The main outcome measure was fracture at any site. We identified a cohort of 3161 HIV-infected patients (869 women and 2292 men) with a total of 587 fractures. The IRR of all fractures was 1.00 (95% confidence interval [CI] 0.83-1.19) between men and women. The IR of fractures at osteoporotic sites among men was 15.2 (95% CI 12.7-17.6) per 1000 person-years compared with 12.1 (95% CI 8.6-15.6) in women, with IRR of 1.26 (95% CI 0.90-1.75). Men had similar or higher IRs than women for osteoporotic site fractures across most age groups. This study found similar rates of fracture in men and women with HIV. Further studies validating these findings are required to determine whether men with HIV should be screened for osteoporosis.