HIV infection and antiretroviral therapies have detrimental effects on bone metabolism, but data on their impact on fracture risk are controversial. We conducted a population-based cohort study to explore the association between clinical diagnosis of HIV infection and hip and major osteoporotic fracture risk. Data were obtained from the SIDIAP(Q) database, which contains clinical information for >2 million patients in Catalonia, Spain (30% of the population). We screened the database to identify participants with a clinical diagnosis of HIV infection, and ascertained incident hip and osteoporotic major fractures in the population aged 40 years or older in 2007 to 2009. In addition, data on incident fractures involving hospital admission were obtained from the Hospital Admissions database. Cox regression models were used to estimate hazard ratios (HRs) for the HIV-infected versus uninfected participants. Models were adjusted for age, sex, body mass index, smoking status, alcohol drinking, oral glucocorticoid use, and comorbid conditions (Charlson index). Among 1,118,156 eligible participants, we identified 2489 (0.22%) subjects with a diagnosis of HIV/AIDS. Age- and sex-adjusted HR for HIV/AIDS were 6.2 (95% confidence interval [CI] 3.5-10.9; p < 0.001) and 2.7 (2.01-3.5; p < 0.001) for hip and major fractures, respectively; this remained significant after adjustment for all mentioned potential confounders: HR 4.7 (2.4-9.5; p < 0.001) and 1.8 (1.2-2.5; p = 0.002). After stratifying by age, the association between HIV infection and major fractures was attenuated for those aged <59 years (adjusted HR 1.35 [0.88-2.07], p = 0.17) but appeared stronger in older patients (adjusted HR 2.11 [1.05-4.22], p = 0.035). We report a strong association between HIV infection and hip fracture incidence, with an almost fivefold increased risk in the HIV infected, independent of sex, age, smoking, alcohol drinking, and comorbidities. Similarly, we demonstrate a 75% higher risk of all clinical fractures and a 60% increase in risk of non-hip clinical fractures among patients with a diagnosis of HIV infection.
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【HIV infection is strongly associated with hip fracture risk, independently of age, gender, and comorbidities: a population-based cohort study.].
【HIV感染与髋部骨折风险密切相关，独立于年龄、性别和合并症: 一项基于人群的队列研究.】
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DOI：10.1002/jbmr.1874文章类型：杂志文章
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HIV感染和抗逆转录病毒疗法对骨代谢有不利影响，但有关其对骨折风险影响的数据仍存在争议。我们进行了一项基于人群的队列研究，以探讨HIV感染的临床诊断与髋部和主要骨质疏松性骨折风险之间的关系。数据是从SIDIAP(Q) 数据库获得的，该数据库包含西班牙加泰罗尼亚> 200万名患者的临床信息 (占人口的30%)。我们对数据库进行了筛选，以识别临床诊断为HIV感染的参与者，并确定了40岁以上人群中发生的髋关节和骨质疏松性主要骨折2007年2009年。此外，从医院入院数据库中获得了涉及入院的突发骨折的数据。Cox回归模型用于估计HIV感染与未感染参与者的风险比 (HRs)。对模型进行了年龄，性别，体重指数，吸烟状况，饮酒，口服糖皮质激素使用和合并症的校正 (Charlson指数)。在1,118,156名符合条件的参与者中，我们确定了2489 (0.22%) 诊断为HIV/AIDS的受试者。对于髋部和主要骨折，年龄和性别校正的HR分别6.2 (95% 置信区间 [CI] 3.5-10.9; P < 0.001) 和2.7 (2.01-3.5; P < 0.001); 在对所有提到的潜在混杂因素进行校正后，这仍然很重要: HR 4.7 (2.4-9.5; P < 0.001) 和1.8 (1.2-2.5; P = 0.002)。按年龄分层后，年龄 <59岁 (调整后的HR 1.35 [0.88-2.07]，p = 0.17) 的患者HIV感染与主要骨折之间的关联减弱，但在老年患者中表现更强 (调整后的HR 2.11 [1.05-4.22]，p = 0.035)。我们报告了HIV感染与髋部骨折发生率之间的密切关联，HIV感染的风险几乎增加了五倍，而与性别，年龄，吸烟，饮酒和合并症无关。同样，我们证明在诊断为HIV感染的患者中，所有临床骨折的风险75% 高，非髋部临床骨折的风险60% 增加。
