Estimating the 10-year fracture risk among persons with HIV and person without HIV: A comparative study
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Keywords

HIV
osteoporotic fractures
hip fractures
10-year risk of fracture
FRAX

Abstract

Background:

The risk of osteoporotic fracture among persons with HIV was higher than the persons without HIV. Traditional factors are also found as the risk factor affecting fracture risk among persons with HIV and general population. Predicting the fracture risk among the high-risk group is important to develop a comprehensive fracture prevention program.

Purpose:

This study aimed to compare the estimation of the 10-year fracture risk between persons with HIV and persons without HIV using the FRAX™ algorithm.

Methods:

This study recruited 245 participants from August to November 2023, while 221 participants agreed to participate. The participants consist of 107 persons with HIV and 114 persons without HIV. The estimation of the ten-year probability of major osteoporotic and hip fractures was calculated using the FRAX™ algorithm. The participant's characteristics related to osteoporotic fracture risk was analyzed using a Chi-Square analysis.

Results:

The overall mean score of 10-year probability of major osteoporotic fracture (MOF) was 3.1% (SD 1.9) for the HIV group and 2.7% (SD 2.3) for non-HIV. For the 10-year probability, hip fracture (HF) risk was 0.5% (SD 0.5) for the HIV group and 0.6% (SD 0.9) for non-HIV. For MOF, HIV persons with fracture history showed a lower score (3.5%) compared to persons without HIV (5.3%). Smoker HIV persons showed the same MOF score (4.6% vs. 4.6%) but lower HF score (0.8% vs. 1.6%) when comparing to persons without HIV, respectively. HIV persons with glucocorticoid use showed a higher MOF probability score than persons without HIV (2.8% vs 2.7%).

Conclusions:

The 10-year fracture risk was higher among persons with HIV compared to persons without HIV. Fracture history, smoking behavior, and glucocorticoid use were identified as the potential factors associated with the risk. Further analysis using multivariate regression analysis may require to confirm the factors associated with high fracture risk.

https://doi.org/10.24198/jkp.v13i1.2715
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References

Bedimo, R., Maalouf, N. M., & Lo Re, V., 3rd. (2016). Hepatitis C virus coinfection as a risk factor for osteoporosis and fracture. Curr Opin HIV AIDS, 11(3), 285-293. https://doi.org/10.1097/coh.0000000000000259

Bedimo, R., Maalouf, N. M., Zhang, S., Drechsler, H., & Tebas, P. (2012). Osteoporotic fracture risk associated with cumulative exposure to tenofovir and other antiretroviral agents. Aids, 26(7), 825-831. https://doi.org/10.1097/QAD.0b013e32835192ae

Brown, T. T., Hoy, J., Borderi, M., Guaraldi, G., Renjifo, B., Vescini, F., Yin, M. T., & Powderly, W. G. (2015). Recommendations for evaluation and management of bone disease in HIV. Clin Infect Dis, 60(8), 1242-1251. https://doi.org/10.1093/cid/civ010

Gedmintas, L., Wright, E. A., Dong, Y., Lehmann, E., Katz, J. N., Solomon, D. H., & Losina, E. (2017). Factors associated with fractures in HIV-infected persons: which factors matter? Osteoporos Int, 28(1), 239-244. https://doi.org/10.1007/s00198-016-3704-6

Gonciulea, A., Wang, R., Althoff, K. N., Palella, F. J., Lake, J., Kingsley, L. A., & Brown, T. T. (2017). An increased rate of fracture occurs a decade earlier in HIV+ compared with HIV- men. Aids, 31(10), 1435-1443. https://doi.org/10.1097/qad.0000000000001493

Hasse, B., Ledergerber, B., Furrer, H., Battegay, M., Hirschel, B., Cavassini, M., Bertisch, B., Bernasconi, E., & Weber, R. (2011). Morbidity and aging in HIV-infected persons: the Swiss HIV cohort study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 53 11, 1130-1139.

Honkanen, R., Tuppurainen, M., Kroger, H., Alhava, E., & Puntila, E. (1997). Associations of early premenopausal fractures with subsequent fractures vary by sites and mechanisms of fractures. Calcif Tissue Int, 60(4), 327-331. https://doi.org/10.1007/s002239900237

Ilha, T., Comim, F. V., Copes, R. M., Compston, J. E., & Premaor, M. O. (2018). HIV and Vertebral Fractures: a Systematic Review and Metanalysis. Sci Rep, 8(1), 7838. https://doi.org/10.1038/s41598-018-26312-9

Jiang, X., Westermann, L. B., Galleo, G. V., Demko, J., Marakovits, K. A., & Schnatz, P. F. (2013). Age as a predictor of osteoporotic fracture compared with current risk-prediction models. Obstet Gynecol, 122(5), 1040-1046. https://doi.org/10.1097/AOG.0b013e3182a7e29b

McCloskey, E. (2009). Identifying people at high risk of fracture International Osteoporosis Foundation. https://www.osteoporosis.foundation/sites/iofbonehealth/files/2020-04/FRAX-Identifying-People-At-High-Risk-of-Fractures.pdf

McGee, D. M., & Cotter, A. G. (2024). HIV and fracture: Risk, assessment and intervention. HIV Med, 25(5), 511-528. https://doi.org/10.1111/hiv.13596

Moran, C. A., Weitzmann, M. N., & Ofotokun, I. (2016). The protease inhibitors and HIV-associated bone loss. Curr Opin HIV AIDS, 11(3), 333-342. https://doi.org/10.1097/coh.0000000000000260

Olofsson, H., Byberg, L., Mohsen, R., Melhus, H., Lithell, H., & Michaëlsson, K. (2005). Smoking and the risk of fracture in older men. J Bone Miner Res, 20(7), 1208-1215. https://doi.org/10.1359/jbmr.050208

Pepe, J., Isidori, A. M., Falciano, M., Iaiani, G., Salotti, A., Diacinti, D., Del Fiacco, R., Sbardella, E., Cipriani, C., Piemonte, S., Romagnoli, E., Lenzi, A., & Minisola, S. (2012). The combination of FRAX and Ageing Male Symptoms scale better identifies treated HIV males at risk for major fracture. Clin Endocrinol (Oxf), 77(5), 672-678. https://doi.org/10.1111/j.1365-2265.2012.04452.x

Pramukti, I., Lindayani, L., Chen, Y. C., Yeh, C. Y., Tai, T. W., Fetzer, S., & Ko, N. Y. (2020). Bone fracture among people living with HIV: A systematic review and meta-regression of prevalence, incidence, and risk factors. PLoS One, 15(6), e0233501. https://doi.org/10.1371/journal.pone.0233501

Pramukti, I., Liu, H. Y., Chen, C. C., Chen, Y. C., Yeh, C. Y., Fetzer, S., Ibrahim, K., Tai, T. W., Ko, W. C., & Ko, N. Y. (2020). HCV co-infection among people living with HIV Is associated with Higher fracture risk. J Infect Public Health, 13(11), 1724-1728. https://doi.org/10.1016/j.jiph.2020.06.020

Prieto-Alhambra, D., Güerri-Fernández, R., De Vries, F., Lalmohamed, A., Bazelier, M., Starup-Linde, J., Diez-Perez, A., Cooper, C., & Vestergaard, P. (2014). HIV infection and its association with an excess risk of clinical fractures: a nationwide case-control study. J Acquir Immune Defic Syndr, 66(1), 90-95. https://doi.org/10.1097/qai.0000000000000112

UNAIDS. (2023). The HIV Epidemic in Asia and the Pacific. https://unaids-ap.org/wp-content/uploads/2023/07/asia-pacific-2023-global-aids-update-summary-report-1.pdf

Ye, C., Morin, S. N., Lix, L. M., McCloskey, E. V., Johansson, H., Harvey, N. C., Kanis, J. A., & Leslie, W. D. (2024). Age at First Fracture and Later Fracture Risk in Older Adults Undergoing Osteoporosis Assessment. JAMA Netw Open, 7(12), e2448208. https://doi.org/10.1001/jamanetworkopen.2024.48208

Yin, M. T., & Falutz, J. (2016). How to predict the risk of fracture in HIV? Curr Opin HIV AIDS, 11(3), 261-267. https://doi.org/10.1097/coh.0000000000000273

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Copyright (c) 2025 Iqbal Pramukti, Kusman Ibrahim, Mamat Lukman, Hasniatisari Harun, Andri Nugraha, Chung-Ying Lin

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