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Fracture Prevalence among Human Immunodeficiency Virus (HIV)-Infected Versus Non-HIV-Infected Patients in a Large U.S. Healthcare System

Division of Infectious Diseases (V.A.T.), Biostatistics Center (H.L.), and Program in Nutritional Metabolism (V.A.T., S.K.G.), Massachusetts General Hospital, Boston, Massachusetts 02114; and Division of Endocrinology and Metabolism (T.T.B.), Johns Hopkins University, Baltimore, Maryland 21287

Address all correspondence and requests for reprints to: Steven K. Grinspoon, M.D., Program in Nutritional Metabolism, Massachusetts General Hospital, 55 Fruit Street, Longfellow 207, Boston, Massachusetts 02114. E-mail: sgrinspoon{at}partners.org.

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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