Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2013 Jul 31;27(12):1949-57.
doi: 10.1097/QAD.0b013e328361d241.

Incident fractures in HIV-infected individuals: a systematic review and meta-analysis

Stephanie Shiau  1 , Emily C Broun, Stephen M Arpadi, Michael T Yin
Affiliations
Meta-Analysis

Incident fractures in HIV-infected individuals: a systematic review and meta-analysis

Stephanie Shiau et al. AIDS. .

Abstract

Objective(s): Some but not all studies indicate that individuals with HIV infection are at an increased risk of fracture. We systematically reviewed the literature to investigate whether incidence of fracture (both overall and fragility) differs between individuals with and without HIV.

Design: A systematic review and meta-analysis.

Methods: Medline, Scopus and the Cochrane Library databases for all studies ever published up to 28 September 2012 and electronically available conference abstracts from CROI, ASBMR, IAS and AIDS were searched. All studies reporting incidence of all fracture and fragility fracture in HIV-infected adults were included. A random effects model was used to calculate pooled estimates of incidence rate ratios (IRRs) for studies that presented data for HIV-infected and controls. For all studies, incidence rates of fracture and predictors of fracture among HIV-infected individuals were summarized.

Results: Thirteen eligible studies were analysed, of which seven included controls. Nine studies reported all incident fractures and 10 presented incident fragility fractures. The pooled IRR was 1.58 [95% confidence interval (CI) 1.25-2.00] for all fracture and 1.35 (95% CI 1.10-1.65) for fragility fracture. Smoking, white race and older age were consistent predictors for fragility fractures.

Conclusion: Our results indicate that HIV infection is associated with a modest increase in incident fracture. Future research should focus on clarifying risk factors, designing appropriate interventions and the long-term implications of this increased risk for an ageing HIV-infected population.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: M.T.Y. has served as a consultant for Gilead and Abbott.

Figures

Fig. 1
Fig. 1. Literature search and study selection
aConferences included: Conference on Retroviruses and Opportunistic Infections (CROI, 1997–2012), the scientific meeting of the American Society for Bone and Mineral Research (ASBMR, 2000–2011), the Conference on HIV Pathogenesis and Treatment of the International AIDS Society (IAS; 2001–2011), and the International AIDS Conference (AIDS; 2002–2012).
Fig. 2
Fig. 2. A meta-analysis of crude incidence rate ratios for all fractures and fragility fractures in HIV-infected compared with controls
(a) All fractures. (b) Fragility fractures. CI, confidence interval.
See this image and copyright information in PMC

References

    1. Jacobson DL, Lindsey JC, Gordon CM, Moye J, Hardin DS, Mulligan K, et al. Total body and spinal bone mineral density across Tanner stage in perinatally HIV-infected and uninfected children and youth in PACTG 1045. AIDS. 2010;24:687–696. - PMC - PubMed
    1. Mulligan K, Harris DR, Emmanuel P, Fielding RA, Worrell C, Kapogiannis BG, et al. Low bone mass in behaviorally HIV-infected young men on antiretroviral therapy: Adolescent Trials Network Study 021B. Clin Infect Dis. 2012;55:461–468. - PMC - PubMed
    1. Brown TT, Qaqish RB. Antiretroviral therapy and the prevalence of osteopenia and osteoporosis: a meta-analytic review. AIDS. 2006;20:2165–2174. - PubMed
    1. Fakruddin JM, Laurence J. HIV-1 Vpr enhances production of receptor of activated NF-kappaB ligand (RANKL) via potentiation of glucocorticoid receptor activity. Arch Virol. 2005;150:67–78. - PubMed
    1. Malizia AP, Cotter E, Chew N, Powderly WG, Doran PP. HIV protease inhibitors selectively induce gene expression alterations associated with reduced calcium deposition in primary human osteoblasts. AIDS Res Hum Retroviruses. 2007;23:243–250. - PubMed

Publication types