An Increased Rate of Fracture Occurs a Decade Earlier in HIV+ Compared to HIV- men in the Multicenter AIDS Cohort Study (MACS).

OBJECTIVES: To determine the incidence and age-related fracture risk among HIV-infected (HIV+) and uninfected men (HIV-). To evaluate factors independently associated with fracture risk.

DESIGN: Prospective, multicenter cohort study of men with or at risk for HIV.

METHODS: Outcome measures: 1) all fractures (excluding skull, face, digits) and 2) fragility fractures (vertebral column, femur, wrist, humerus) were collected semiannually in 1221 HIV+ and 1408 HIV- men ≥ age 40. Adjusted incident rate ratios (aIRR) with an interaction term for age (40-49, 50-59, ≥60 years) and HIV serostatus were estimated with Poisson regression models accounting for additional risk factors.

RESULTS: Fracture incidence increased with age among both HIV+ and HIV- men. While there was no significant difference in fracture incidence by HIV serostatus among men aged 40-49 years, the HIV+ men aged 50-59 years had a significantly higher incidence of all fractures (aIRR = 2.06 [1.49, 2.84]) and fragility fractures (aIRR = 2.06 [1.21, 3.50]) compared with HIV- participants of similar age. HIV modified the effect of age on all fractures (p = 0.002) but did not significantly modify the effect for fragility fractures (p = 0.135). Hypertension increased the rate of all fractures by 32% after adjustment for covariates (aIRR = 1.32 [1.04, 1.69]).

CONCLUSIONS: Fracture incidence increased with age among HIV+ and HIV- men but was higher among HIV+ men. A significant increase in fracture incidence was found among 50-59-year-old HIV+ men, highlighting the importance of osteoporosis screening for HIV infected men above the age of 50.