Assessing the contributions of modifiable risk factors to serious falls and fragility fractures among older persons living with HIV

Abstract

Background Although 50 years represents middle age among uninfected individuals, studies have shown that persons living with HIV (PWH) begin to demonstrate elevated risk for serious falls and fragility fractures in the sixth decade; the proportions of these outcomes attributable to modifiable factors are unknown. Methods We analyzed 21,041 older PWH on antiretroviral therapy (ART) from the Veterans Aging Cohort Study from 01/01/2010 through 09/30/2015. Serious falls were identified by Ecodes and a machine‐learning algorithm applied to radiology reports. Fragility fractures (hip, vertebral, and upper arm) were identified using ICD9 codes. Predictors for both models included a serious fall within the past 12 months, body mass index, physiologic frailty (VACS Index 2.0), illicit substance and alcohol use disorders, and measures of multimorbidity and polypharmacy. We separately fit multivariable logistic models to each outcome using generalized estimating equations. From these models, the longitudinal extensions of average attributable fraction (LE‐AAF) for modifiable risk factors were estimated. Results Key risk factors for both outcomes included physiologic frailty (VACS Index 2.0) (serious falls [15%; 95% CI 14%–15%]; fractures [13%; 95% CI 12%–14%]), a serious fall in the past year (serious falls [7%; 95% CI 7%–7%]; fractures [5%; 95% CI 4%–5%]), polypharmacy (serious falls [5%; 95% CI 4%–5%]; fractures [5%; 95% CI 4%–5%]), an opioid prescription in the past month (serious falls [7%; 95% CI 6%–7%]; fractures [9%; 95% CI 8%–9%]), and diagnosis of alcohol use disorder (serious falls [4%; 95% CI 4%–5%]; fractures [8%; 95% CI 7%–8%]). Conclusions This study confirms the contributions of risk factors important in the general population to both serious falls and fragility fractures among older PWH. Successful prevention programs for these outcomes should build on existing prevention efforts while including risk factors specific to PWH.

Polypharmacy Is Associated With Slow Gait Speed and Recurrent Falls in Older People With HIV

“…However, less is known about the relationship between polypharmacy and adverse outcomes in PWH and whether there are sex differences in polypharmacy in PWH after accounting for potential differences in comorbidities [ 18–21 ]. Prior studies of polypharmacy in PWH found associations between polypharmacy and adverse outcomes, including serious falls [ 22 ] and impaired cognition [ 19 ]. However, a key factor that limits our understanding of the relationship between polypharmacy and adverse outcomes in PWH with virologic suppression is the paucity of studies that have focused on large cohorts of mixed-sex, aging PWH on ART, with a detailed inventory of medication use alongside detailed accounting of comorbidities and other important confounding factors.…”