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This version published online on July 1, 2008
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2008-0828
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Submitted on April 16, 2008
Accepted on June 25, 2008

Fracture Prevalence among HIV-Infected versus Non HIV-Infected Patients in a Large U.S. Healthcare System

Virginia A. Triant MD, MPH, Todd T. Brown MD, PhD, Hang Lee PhD, and Steven K. Grinspoon MD*

From the Brigham and Women's Hospital (BWH) and Massachusetts General Hospital (MGH) Divisions of Infectious Diseases (VAT), Johns Hopkins University Division of Endocrinology (TTB), MGH Biostatistics Center (HL), MGH Program in Nutritional Metabolism (SKG and VAT), Boston, MA 02114

* To whom correspondence should be addressed. E-mail: sgrinspoon{at}partners.org.

Context: Reduced bone mineral density has been demonstrated among HIV-infected patients, but fracture prevalence is unknown.

Objective: To compare fracture prevalence in HIV-infected and non HIV-infected patients.

Design: Population-based study.

Setting: A large U.S. healthcare system.

Patients: 8,525 HIV-infected and 2,208,792 non HIV-infected patients with at least one inpatient or outpatient encounter between October 1, 1996 and March 21, 2008 were compared.

Main Outcome Measure: Fracture prevalence using specific ICD-9-CM fracture codes.

Results: The overall fracture prevalence was 2.87 versus 1.77 patients with fractures per 100 persons in HIV-infected compared to non HIV-infected patients (P<0.0001). Among females, the overall fracture prevalence was 2.49 versus 1.72 per 100 persons in HIV-infected versus non HIV-infected patients (P=0.002). HIV-infected females had a higher prevalence of vertebral (0.81 vs. 0.45; P=0.01) and wrist (1.31 vs. 0.83; P=0.01) fractures per 100 persons compared to non HIV-infected females but had a similar prevalence of hip fractures (0.47 vs. 0.56; P=0.53). Among males, the fracture prevalence per 100 persons was higher in HIV-infected versus non HIV-infected patients for any fracture (3.08 vs. 1.83; P<0.0001), vertebral fractures (1.03 vs. 0.49; P<0.0001), hip fractures (0.79 vs. 0.45; P=0.001) and wrist fractures (1.46 vs. 0.99; P=0.001). Fracture prevalence was higher relative to non HIV-infected patients among African-American and Caucasian females and Caucasian males.

Conclusions: Fracture prevalence is increased in HIV-infected compared to non HIV-infected patients.
Key words: HIV • fracture • bone






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