Fragility fractures and bone mineral density in HIV positive women: a case-control population-based study
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This Canadian study of bone health showed that HIV+ women were more likely to have had fragility fractures (OR 1.7) but had BMD values that were not different than women from a national population-based cohort.
Given that 17.5 million women globally are HIV-infected and living longer on anti-retroviral therapy (ART+), it is essential to determine whether they are at risk for osteoporosis as is currently assumed.
Assessment of osteoporosis risk factors and lifetime low-trauma (fragility) fracture history used a common interviewer-administered questionnaire and phantom-adjusted bone mineral density (BMD). This study compared HIV+ Canadian women with age- and region-matched control women (1:3) from a national population-based study of osteoporosis.
One hundred and thirty-eight HIV+ women (100 ART+, 38 ART-) were compared with 402 controls. There were no differences in age (37.7 vs. 38.0 years), BMI (25.0 vs. 26.2), family history of osteoporosis, exercise history, alcohol or calcium intakes, age at menarche, oral contraceptive use or parity. HIV+ cases included more Aboriginal and Black women (12.5% and 16.2 vs. 2% and 1%, respectively), smoked and used injection drugs (53%) more, were more often treated with glucocorticoids, had oligomenorrhea, and reported 10-kg weight cycling. Significantly more HIV+ women reported lifetime fragility fractures (26.1% vs. 17.3; OR 1.7, 95% CI 1.1, 2.6). HIV+ and control women did not differ in BMD: spine 1.0 ± 0.12 vs.1.0 ± 0.14 g/cm2 (diff. 0.0, 95% CI −0.27, 0.27) or total femur 0.91 ± 0.15 vs. 0.93 ± 0.12 g/cm2 (diff 0.02, 95% CI +0.005, −0.045).
HIV+ women reported significantly more past osteoporotic fractures than population-based controls despite normal BMD. Research is needed to assess bone microarchitecture and develop a reliable fracture risk assessment tool for HIV+ women.
KeywordsBone mineral density Case-population-control Fragility fractures HIV positive Premenopausal Women
The authors thank all the women who participated. This study would not have been possible without approval from the Data Analysis and Publications Committee of the Canadian Multicentre Osteoporosis Study and the cooperation of C. Berger and the CaMOS Data Management Centre. Dr. D. Burdge and C. Morris obtained funding for this study as a grant from CANFAR. The following physician directors of individual Canadian Women’s HIV Study centres, in addition to the authors (DRB, CH, MBK and SW) contributed importantly to this study: A Rachlis; F. Smaill; S Trottier, W Wobeser, and K Williams. The bone mineral density measurements were made possible with the assistance of Dr. K. Kruse and the Osteoporosis Clinic at the Women’s Health Centre in Vancouver. Dr. Stuart Jackson provided quality assurance and converted all DXA data based on common phantom data. Dr. R. Sebaldt oversaw data entry for the CWHS data.
The Canadian Multicentre Osteoporosis Study was funded by the Senior’s Independence Research Program, through the National Health Research and Development Program of Health Canada (Project No. 6605-4003-OS), The Medical Research Council of Canada, MRC-PMAC Health Program, Merck Frosst Canada Inc., Eli Lilly Canada Inc., Procter and Gamble Pharmaceuticals Canada Inc., Novartis Pharmaceuticals Inc., Aventis Pharma Inc., The Dairy Farmers of Canada, The Arthritis Society.
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