Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Fracture Epidemiology among a Cohort of HIV-Infected Adults in the UK: An Epidemiologic Study.
Walker-Bone1, Karen, Malik2, Reshad, Fisher2, Martin, Gilleece2, Yvonne, Samarawickrama2, Amanda
HIV is a global pandemic. The devastating mortality associated with HIV infection has been dramatically reduced by highly-active anti-retroviral therapies (HAART). However, this has led to increasing numbers of HIV-infected patients living with comorbidities including metabolic diseases. Low bone mass and osteoporosis were implicated as consequences of HAART approximately 10 years ago but fracture data in HIV-infected populations are rare.
A well-characterised cohort of HIV-infected adults attending one UK centre for outpatient care was surveyed. Trained nurses administered a questionnaire which enquired about demographic factors, lifestyle factors, diet and exercise, exposure to glucocorticoids and other drugs affecting bone mineral and HIV factors. Exposure to HAART, stage of HIV infection and status of viral load, CD4 counts etc were collated.
In total, 1050 HIV infected adults were surveyed. 859 (82%) responded. Mean age of respondents was 42.7 (range 1977) years. 87% were Caucasian and 90% were male (predominant mode of transmission of infection: MSM). Mean duration of HIV infection was 6 years and 76% were current users of ARVs. Overall, 125 subjects (119 (15%) men and 6 women (7%)) reported 200 fractures. 65 respondents had fractured their distal forearm, 6 reported hip fractures and 2 vertebral fractures. In total, 57% of the 200 fractures occcurred under age 25 years with the peak age 712 years. However, 33 fractures (26%) occurred among respondetns aged >40 years and 8 (24% among those aged >50 years. The second peak of fractures occurred at the distal forearm (n=6, mean age 48.2 years) and there was 1 hip fracture (age 46 years). 15% of those who sustained a fracture at aged >40 years had been exposed to oral glucocorticoids as compared to 9% of those who had not fractured.
Our results suggest a traditional bimodal distribution of fracture in this population. The first peak occurs in childhood/adolescence and is maximal aged 712 years. However, our results suggest a second peak of fracture aged >40 years at sites with a high proportion of trabecular bone (distal forearm, hip, vertebrae). This peak is seen much earlier than in non-HIV infected adults but affects similar sites to those of traditional osteoporotic fractures. Although low bone mass has been documented widely in prevalent HIV infection, fracture has not. Our data suggest that fracture may be a consequence of low bone mass in HIV infection. If these data are replicated, HIV may become one of the most important causes of secondary osteoporosis worldwide.
To cite this abstract, please use the following information:
Walker-Bone, Karen, Malik, Reshad, Fisher, Martin, Gilleece, Yvonne, Samarawickrama, Amanda; Fracture Epidemiology among a Cohort of HIV-Infected Adults in the UK: An Epidemiologic Study. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :966