by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer
August 10, 2021
Battalora L, Armon C, Palella F, et al. Incident bone fracture and mortality in a large HIV cohort outpatient study, 2000-2017, USA. Arch Osteoporos. 2021 Aug 2; 16(1): 117. doi: 10.1007/s11657-021-00949-y. PMID: 34337687.
Investigators with the HIV Outpatient Study (HOPS) sought to evaluate the association of bone fracture with mortality. This analysis included 6,763 participants contributing 51,443 person-years of follow-up: 504 (7.5%) had incident fracture recorded. Of the 504 fractures, 135 (26.8%) were major osteoporotic fractures. At baseline, participants who later experienced incident fracture were older and more likely to: be a current or prior smoker, have 7 or more alcoholic beverages per week at HOPS cohort entry, have been diagnosed with HIV for longer duration, have an AIDS diagnosis, be ART experienced, and have lower nadir CD4. Incident fracture was associated with a nearly 50% increase in risk of all-cause mortality. Subset analysis of participants who experienced fracture revealed a mortality rate of 2.97 (CI 0.86-2.05) per 100 PY for persons with major osteoporotic fractures. All-cause mortality was significantly associated with having any of the following chronic conditions: cardiovascular disease, chronic kidney disease, HCV coinfection, pulmonary disease, or history of non-AIDS cancer.
Post-fracture mortality in the general population has been linked to various comorbidities, however the relationship between fractures and mortality among PWH is less clear. This study is unique in that its primary aim was to evaluate mortality rates after fracture in a large, prospective cohort of PWH well-engaged in care. Findings reinforce the importance of prevention (especially counseling and treatment to reduce tobacco and alcohol use, and education on the importance of physical activity), screening, and treatment of bone density loss. Routine assessment of fall risk is also prudent. Further studies examining this issue are important to help improve health outcomes and medical care of aging PWH.
The author has no conflicts of interest to disclose.
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