Paper # 129
HIV-infection and Fragility Fracture Risk among Male Veterans
Julie Womack*1, J Goulet1, C Gibert2, C Brandt1,3, K Mattocks1,4, D Rimland5, M Rodriguez-Barradas6, J Tate1, M Yin7, J Amy1,4, and Veterans Aging Cohort Project Team
1VA Connecticut Hlthcare System, West Haven VAMC, US; 2George Washington Univ Sch of Med and Washington DC VAMC, US; 3Yale Ctr for Med Informatics, Yale Univ, New Haven, CT, US; 4Yale Sch of Med, New Haven, CT, US; 5Emory Univ Sch of Med and Atlanta VAMC, GA, US; 6Michael E De Bakey VAMC, Baylor Coll of Med, Houston, TX, US; and 7Columbia Univ, Coll of Physicians and Surgeons, New York, NY, US
Background: Decreased bone mineral density is more
common in HIV-infected than uninfected individuals. Previous authors have
documented increased wrist, hip, and vertebral fractures (fragility fractures)
among HIV-infected as compared to uninfected individuals, however none has adjusted
for body mass index (BMI), comorbidity, or alcohol abuse.
Methods: Our sample included 105,706 men (40,216
HIV-infected and 64,971 uninfected) enrolled in the Veterans Aging Cohort Study
(VACS) virtual cohort, a prospective cohort study of HIV-infected and
uninfected Veterans. Cox proportional hazard models were used to estimate the
hazard ratio (HR) for fragility fractures in HIV-infected compared to
uninfected Veterans. Adjusted models included age, HIV serostatus, race, body
mass index, and comorbid medical and psychiatric conditions associated with
fragility fracture risk. Because wrist fractures were more common among younger
men regardless of HIV serostatus, we excluded them from the analysis.
Results: In this study, 952 (644 hip and 308
vertebral) fractures were observed during a median follow-up of 8 (4 to 11)
years. Mean age at fracture was 55 (SD:11) years. Unadjusted incidence of
vertebral and hip fractures was 16 for HIV-infected and 11 for uninfected Veterans/10,000
person-years of follow-up (P <0.0001) and increased
substantially with age (P <0.0001). Compared to uninfected
Veterans and after adjustment for white race (HR = 1.79, 95%CI 1.57 to 2.03),
BMI <19 (HR = 2.50, 1.54 to 4.05), alcohol abuse (HR = 1.79, 1.47 to 2.18),
pulmonary disease (HR = 1.38, 1.10 to 1.73), cerebrovascular disease (HR =
2.16, 1.54 to 3.02), and peripheral vascular disease (HR = 1.64, 1.10 to 2.44),
HIV infection was not independently associated with fragility fracture (HR =
1.20, 0.99 to 1.45). However, HIV-infection in Veterans >50 years of
age contributed additional, significant risk for fracture (HR = 1.37, 1.06 to 1.78).
Conclusions: Wrist fractures were associated with
younger age in this sample of aging male Veterans. In contrast hip and
vertebral fractures were strongly associated with age. After adjustment for
established risk factors, HIV was associated with increased risk only among
older Veterans.
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