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Increased Risk of Fragility Fractures among HIV Infected Compared to Uninfected Male Veterans
Open accessAbstract
BACKGROUND: HIV infection has been associated with an increased risk of fragility fracture. We explored whether or not this increased risk persisted in HIV infected and uninfected men when controlling for traditional fragility fracture risk factors. METHODOLOGY/PRINCIPAL FINDINGS: Cox regression models were used to assess the association of HIV infection with the risk for incident hip, vertebral, or upper arm fracture in male Veterans enrolled in the Veterans Aging Cohort Study Virtual Cohort (VACS-VC). We calculated adjusted hazard ratios comparing HIV status and controlling for demographics and other established risk factors. The sample consisted of 119,318 men, 33% of whom were HIV infected (34% aged 50 years or older at baseline, and 55% black or Hispanic). Median body mass index (BMI) was lower in HIV infected compared with uninfected men (25 vs. 28 kg/m²; p<0.0001). Unadjusted risk for fracture was higher among HIV infected compared with uninfected men [HR: 1.32 (95% CI: 1.20, 1.47)]. After adjusting for demographics, comorbid disease, smoking and alcohol abuse, HIV infection remained associated with an increased fracture risk [HR: 1.24 (95% CI: 1.11, 1.39)]. However, adjusting for BMI attenuated this association [HR: 1.10 (95% CI: 0.97, 1.25)]. The only HIV-specific factor associated with fragility fracture was current protease inhibitor use [HR: 1.41 (95% CI: 1.16, 1.70)]. CONCLUSIONS/SIGNIFICANCE: HIV infection is associated with fragility fracture risk. This risk is attenuated by BMI.
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Metadata
- Authors
- Womack, J. A., Goulet, J. L., Gibert, C., Brandt, C., Chang, C. C., Gulanski, B., Fraenkel, L., Mattocks, K., Rimland, D., Rodriguez-Barradas, M. C., Tate, J., Yin, M. T., Justice, A. C., & for the Veterans Aging Cohort Study Project Team
- Affiliations
- VA Connecticut Healthcare System (US)
- George Washington University (US)
- Yale University (US)
- University of Pittsburgh (US)
- Emory University (US)
- Columbia University Irving Medical Center (US)
- Corresponding author
- Womack, Julie A.
- ORCID
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2011-02-16
- Volume
- 6
- Issue
- 2
- Pages
- e17217
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3040233
- OpenAlex
- W2155638837
- Cited by
- 261
- References
- 60
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 7 · 2023: 8 · 2022: 5 · 2021: 16 · 2020: 16 · 2019: 8 · 2018: 18 · 2017: 17 · 2016: 23 · 2015: 25 · 2014: 32 · 2013: 31 · 2012: 31
- FWCI
- 39.95
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, public-domain)
- PubMed Central (publishedVersion, public-domain)
- PubMed (publishedVersion)
- D-Scholarship@Pitt (University of Pittsburgh) (acceptedVersion)
- The Journal of the American Medical Association (JAMA) Network (American Medical Association) (submittedVersion, public-domain)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- U.S. Department of Veterans Affairs
- National Institute on Alcohol Abuse and Alcoholism (U10AA013566, U10- AA13566)
- National Institute of Nursing Research (K01NR013437)
- National Institute of Allergy and Infectious Diseases (K23AI059884)
- Topics
- Health Sciences › Medicine › Infectious Diseases › HIV-related health complications and treatments
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Keywords
- HIV infection, fragility fractures, hip fracture, vertebral fractures, upper arm fractures, male veterans, body mass index, protease inhibitors, fracture risk factors, aging
- MeSH terms
- Aged, Aged, 80 and over, Follow-Up Studies, Humans, Male, Middle Aged, Osteoporosis, Risk Factors, Sex Characteristics, Veterans, HIV-1, Bone Density, HIV Infections, Fractures, Bone
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