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People with HIV infection had lower bone mineral density and increased fracture risk: a meta-analysis

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Abstract

Summary

A meta-analysis to investigate the difference in fracture risk between individuals with and without HIV infection was performed. People living with HIV had lower bone mineral density (BMD) and greater risks of overall fractures and fragility fractures. Reducing fragility and maintaining skeletal strength for PLWH are urgently needed for this population.

Purpose

The introduction of effective antiretroviral therapy increased the life expectancy of people living with HIV (PLWH). This population now faces problems related to aging such as decreased bone mineral density (BMD) and increased fracture risk. Some antiretroviral therapies may also negatively impact bone health. We performed a meta-analysis to investigate the difference in the fracture risk between individuals with and without HIV infection.

Methods

We compared BMD, risk of fragility fracture, and risk of all fracture between the two groups. This study included 35 articles with 106,994 PLWH and 228,794,335 controls.

Results

PLWH had lower lumbar spine and hip BMD than controls. PLWH had a higher prevalence of all fracture events (4.08% versus 0.44%) and fragility fractures (2.66% versus 2.19%). The relative risks of all and fragility fractures of PLWH were 1.91 (95% confidence interval (CI), 1.46–2.49; p < 0.001) and 1.68 (95% CI: 1.40–2.01; p < 0.001). PLWH also had more vertebral fractures (1.26% versus 0.37%; RR, 1.97; 95% CI: 1.22–3.2; p < 0.05), hip fractures (1.38% versus 0.81%; RR, 1.88; 95% CI: 0.99–3.57; p = 0.05), and wrist fractures (1.38% versus 1.29%; RR, 1.67; 95% CI: 1.13–2.45; p < 0.05) than healthy controls. The pooled incidence of fractures was 1.72 per 100 person-years in PLWH and 1.29 in healthy controls.

Conclusion

PLWH had lower BMD and greater risks of all fractures and fragility fractures. Reducing fragility and maintaining skeletal strength for PLWH are urgently needed for this population.

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Authors and Affiliations

  1. Departments of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan

    Chao-Jui Chang & Ta-Wei Tai

  2. Department of Life Science, Chinese Culture University, Taipei, Taiwan

    Yi-Lin Chan

  3. Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Iqbal Pramukti & Nai-Ying Ko

  4. Faculty of Nursing, Universitas Padjadjaran, , West Java, Bandung, Indonesia

    Iqbal Pramukti

  5. Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Ta-Wei Tai

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Chang, CJ., Chan, YL., Pramukti, I. et al. People with HIV infection had lower bone mineral density and increased fracture risk: a meta-analysis. Arch Osteoporos 16, 47 (2021). https://doi.org/10.1007/s11657-021-00903-y

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