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J Clin Endocrinol Metab. 2008 Sep;93(9):3499-504. doi: 10.1210/jc.2008-0828. Epub 2008 Jul 1.

Fracture prevalence among human immunodeficiency virus (HIV)-infected versus non-HIV-infected patients in a large U.S. healthcare system.

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  • 1Program in Nutritional Metabolism, Massachusetts General Hospital, 55 Fruit Street, Longfellow 207, Boston, Massachusetts 02114. sgrinspoon@partners.org.

Abstract

CONTEXT:

Reduced bone mineral density has been demonstrated among HIV-infected patients, but fracture prevalence is unknown.

OBJECTIVE:

The objective of the study was to compare fracture prevalence in HIV-infected and non-HIV-infected patients.

DESIGN:

This was a population-based study.

SETTING:

The study was conducted at a large U.S. health care system.

PATIENTS:

A total of 8525 HIV-infected and 2,208,792 non-HIV-infected patients with at least one inpatient or outpatient encounter between October 1, 1996, and March 21, 2008, was compared.

MAIN OUTCOME MEASURE:

Fracture prevalence using specific International Classification of Diseases, Ninth Revision, Clinical Modification fracture codes was measured.

RESULTS:

The overall fracture prevalence was 2.87 vs. 1.77 patients with fractures per 100 persons in HIV-infected, compared with non-HIV-infected patients (P < 0.0001). Among females, the overall fracture prevalence was 2.49 vs. 1.72 per 100 persons in HIV-infected vs. non-HIV-infected patients (P = 0.002). HIV-infected females had a higher prevalence of vertebral (0.81 vs. 0.45; P = 0.01) and wrist (1.31 vs. 0.83; P = 0.01) fractures per 100 persons, compared with non-HIV-infected females but had a similar prevalence of hip fractures (0.47 vs. 0.56; P = 0.53). Among males, the fracture prevalence per 100 persons was higher in HIV-infected vs. non-HIV-infected patients for any fracture (3.08 vs. 1.83; P < 0.0001), vertebral fractures (1.03 vs. 0.49; P < 0.0001), hip fractures (0.79 vs. 0.45; P = 0.001), and wrist fractures (1.46 vs. 0.99; P = 0.001). Fracture prevalence was higher relative to non-HIV-infected patients among African-American and Caucasian females and Caucasian males.

CONCLUSIONS:

Fracture prevalence is increased in HIV-infected compared with non-HIV-infected patients.

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