Brief Report: Are Serious Falls Associated With Subsequent Fragility Fractures Among Veterans Living With HIV?

Womack, Julie A.; Murphy, Terrence E.; Ramsey, Christine M.; Bathulapalli, Harini; Smith, Alexandria; Bates, Jonathan; Jarad, Samah; Gill, Thomas M; Hsieh, Evelyn; Rodriguez‐Barradas, Maria C.; Tien, Phyllis C.; Yin, Michael T.; Brandt, Cynthia; Justice, Amy C.

doi:10.1097/qai.0000000000002752

Cited by 7 publications

(24 citation statements)

References 52 publications

(67 reference statements)

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“…The variation in fracture risk observed in these studies suggests that different factors are involved in associating HIV with low BMD. For instance, in the meta-analysis conducted by O’Neill et al and Dong et al, it was shown that co-infection with HCV in PLWHIV is associated with a higher risk of bony fractures than those monoinfected with HIV [ 12 , 13 ]. Fractures are likely to occur in those aged between 40 to 59 years old, and it has been suggested that a fracture is likely to occur 10 years earlier in PLWHIV in comparison with the non-HIV-infected population [ 20 , 21 , 22 ].…”

Section: Prevalence Of Fracture In Association With Hivmentioning

confidence: 99%

“…The combination of a number of risk factors in people co-infected with HCV and HIV might explain the population’s elevated fracture risk. As in the general population, serious falls within the preceding year requiring medical attention are also major predictors of fragility fractures among PLWHIV receiving ARV [ 13 ]. Therefore, metabolic and endocrine disorders, especially osteoporosis, are best managed in a dedicated metabolic HIV clinic [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Bone Health in People Living with HIV/AIDS: An Update of Where We Are and Potential Future Strategies

et al. 2023

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The developments in Human Immunodeficiency Virus (HIV) treatment and in the care of people living with HIV (PLWHIV) and Acquired Immunodeficiency Syndrome (AIDS) over the last three decades has led to a significant increase in life expectancy, on par with HIV-negative individuals. Aside from the fact that bone fractures tend to occur 10 years earlier than in HIV-negative individuals, HIV is, per se, an independent risk factor for bone fractures. A few available antiretroviral therapies (ARVs) are also linked with osteoporosis, particularly those involving tenofovir disoproxil fumarate (TDF). HIV and hepatitis C (HCV) coinfection is associated with a greater risk of osteoporosis and fracture than HIV monoinfection. Both the Fracture Risk Assessment Tool (FRAX) and measurement of bone mineral density (BMD) via a DEXA scan are routinely used in the assessment of fracture risk in individuals living with HIV, as bone loss is thought to start between the ages of 40 and 50 years old. The main treatment for established osteoporosis involves bisphosphonates. Supplementation with calcium and vitamin D is part of clinical practice of most HIV centers globally. Further research is needed to assess (i) the cut-off age for assessment of osteoporosis, (ii) the utility of anti-osteoporotic agents in PLWHIV and (iii) how concomitant viral infections and COVID-19 in PLWHIV can increase risk of osteoporosis.

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Section: Prevalence Of Fracture In Association With Hivmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bone Health in People Living with HIV/AIDS: An Update of Where We Are and Potential Future Strategies

et al. 2023

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“…24 Although all of these factors are likely important concerns among older PWH, other key risk factors such as alcohol and substance use are not addressed. 7 There are many modifiable risk factors that might serve as the basis for interventions. However, we have yet to objectively assess which of these modifiable risk factors accounts for the greatest proportion of serious falls and fragility fractures among older PWH.…”

Section: Why Does This Paper Matter?mentioning

confidence: 99%

“…[1][2][3][4][5][6] Among older PWH (50+ years), falls and fragility fractures are key comorbidities. [7][8][9][10] Research suggests that older PWH experience a higher prevalence of falls and fragility fractures than the general population. 9,[11][12][13] Many of these occur among older PWH who are chronologically middle-aged and in their most economically productive years.…”

Section: Introductionmentioning

confidence: 99%

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

Womack

Murphy

Bates

et al. 2023

J American Geriatrics Society

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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.

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“…The combination of several of these risk factors in patients co-infected with HIV and hepatitis C could explain the particularly increased risk of fractures in this population. Serious falls within the past year, significant enough to warrant a visit to a health care provider, are also, as in the general population, strong predictors of fragility fractures in PLWH on ART [ 44 ].…”

Section: Pathophysiology and Risk Factors Of Osteoporosis And Bone Fr...mentioning

confidence: 99%

Osteoporosis and HIV Infection

Biver

2022

Calcif Tissue Int

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Life expectancy of people living with HIV (PLWH) is now close to that of the HIV-uninfected population. As a result, age-related comorbidities, including osteoporosis, are increasing in PLWH. This narrative review describes the epidemiology of bone fragility in PLWH, changes of bone features over the course of HIV infection and their determinants, as well as the available evidence regarding the management of osteoporosis in PLWH. The risk of fracture is higher and increases about 10 years earlier compared to the general population. The classical risk factors of bone fragility are very widespread and are major determinants of bone health in this population. The majority of bone loss occurs during virus replication and during immune reconstitution at antiretroviral therapies (ART) initiation, which both increase osteoclast activity. Abnormalities in bone formation and mineralization have also been shown in histomorphometric studies in untreated PLWH. Measurement of bone mineral density (BMD) is the first line tool for assessing fracture risk in postmenopausal women, men above 50 years, and other HIV-infected patients with clinical risk factors for osteoporosis. FRAX underestimates fracture probability in PLWH. In case of indication for anti-osteoporotic drug, bisphosphonates remain the reference option. Calcium and vitamin D supplementation should be considered as ART initiation, since it may attenuate bone loss at this stage. Bone-protective ART regimens improve BMD compared to other regimens, but to a lesser extent than bisphosphonate, and without available data on their influence on the incidence of fracture.

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Brief Report: Are Serious Falls Associated With Subsequent Fragility Fractures Among Veterans Living With HIV?

Cited by 7 publications

References 52 publications

Bone Health in People Living with HIV/AIDS: An Update of Where We Are and Potential Future Strategies

Bone Health in People Living with HIV/AIDS: An Update of Where We Are and Potential Future Strategies

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

Osteoporosis and HIV Infection

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