Meta-analysis of 13 studies determined that HIV-positive people have a slightly but significantly higher risk of fracture when compared with control groups. Traditional risk factors, including smoking, consistently raised fracture risk from study to study.
Research has yielded conflicting results on whether HIV infection makes fragility fractures or all fractures more likely. To address this question, US investigators searched online databases for all studies up to 28 September 2012 that reported incidence (new diagnosis) of all fractures and fragility fractures in HIV-positive adults. They used random effects models to calculate pooled estimates of incidence rate ratios (IRR) for studies that compared HIV-positive people with a control population.
The researchers found 13 eligible studies, 7 of which included a control population. Nine studies counted all incident fractures, and 10 studies counted incident fragility fractures (which indicate low bone mineral density).
For all fractures the pooled IRR was 1.58 (95% confidence interval 1.25 to 2.00), meaning HIV-positive people had a 58% higher incidence of all fractures than the comparison population. For fragility fractures the pooled IRR was 1.35 (95% confidence interval 1.10 to 1.65).
Three classic fracture risk factors consistently predicted fragility fractures in these studies—smoking, white race, and older age.
The authors conclude that their results “indicate that HIV infection is associated with a modest increase in incident fracture.”
They suggest that future research “should focus on clarifying risk factors, designing appropriate interventions and the long-term implications of this increased risk for an ageing HIV-infected population.”
