Unitat de Recerca en Fisiopatologia Òssia i Articular-URFOA, IMIM-Parc de Salut Mar, Barcelona, Spain.
J Bone Miner Res. 2013 Jun;28(6):1259-63. doi: 10.1002/jbmr.1874.
HIV infection and antiretroviral therapies have detrimental effects on bone metabolism, but data on their impact on fracture risk are controversial. We conducted a population-based cohort study to explore the association between clinical diagnosis of HIV infection and hip and major osteoporotic fracture risk. Data were obtained from the SIDIAP(Q) database, which contains clinical information for >2 million patients in Catalonia, Spain (30% of the population). We screened the database to identify participants with a clinical diagnosis of HIV infection, and ascertained incident hip and osteoporotic major fractures in the population aged 40 years or older in 2007 to 2009. In addition, data on incident fractures involving hospital admission were obtained from the Hospital Admissions database. Cox regression models were used to estimate hazard ratios (HRs) for the HIV-infected versus uninfected participants. Models were adjusted for age, sex, body mass index, smoking status, alcohol drinking, oral glucocorticoid use, and comorbid conditions (Charlson index). Among 1,118,156 eligible participants, we identified 2489 (0.22%) subjects with a diagnosis of HIV/AIDS. Age- and sex-adjusted HR for HIV/AIDS were 6.2 (95% confidence interval [CI] 3.5-10.9; p < 0.001) and 2.7 (2.01-3.5; p < 0.001) for hip and major fractures, respectively; this remained significant after adjustment for all mentioned potential confounders: HR 4.7 (2.4-9.5; p < 0.001) and 1.8 (1.2-2.5; p = 0.002). After stratifying by age, the association between HIV infection and major fractures was attenuated for those aged <59 years (adjusted HR 1.35 [0.88-2.07], p = 0.17) but appeared stronger in older patients (adjusted HR 2.11 [1.05-4.22], p = 0.035). We report a strong association between HIV infection and hip fracture incidence, with an almost fivefold increased risk in the HIV infected, independent of sex, age, smoking, alcohol drinking, and comorbidities. Similarly, we demonstrate a 75% higher risk of all clinical fractures and a 60% increase in risk of non-hip clinical fractures among patients with a diagnosis of HIV infection.
HIV 感染和抗逆转录病毒治疗对骨代谢有不良影响，但关于它们对骨折风险影响的数据仍存在争议。我们进行了一项基于人群的队列研究，以探讨临床诊断的 HIV 感染与髋部和主要骨质疏松性骨折风险之间的关系。数据来自 SIDIAP(Q)数据库，该数据库包含西班牙加泰罗尼亚地区超过 200 万名患者的临床信息（占人口的 30%）。我们筛选了该数据库以确定有临床诊断的 HIV 感染的参与者，并确定了 2007 年至 2009 年期间年龄在 40 岁及以上人群中的髋部和主要骨质疏松性骨折的发病情况。此外，还从住院患者数据库中获取了与骨折发病相关的入院数据。使用 Cox 回归模型估计感染 HIV 与未感染 HIV 的参与者的风险比（HR）。模型调整了年龄、性别、体重指数、吸烟状况、饮酒、口服糖皮质激素的使用以及合并症（Charlson 指数）。在 1118156 名符合条件的参与者中，我们确定了 2489 名（0.22%）诊断为 HIV/AIDS 的患者。HIV/AIDS 的年龄和性别调整 HR 分别为 6.2（95%置信区间[CI]为 3.5-10.9；p<0.001）和 2.7（2.01-3.5；p<0.001）髋部和主要骨折；在调整所有潜在混杂因素后，这仍然具有统计学意义：HR 4.7（2.4-9.5；p<0.001）和 1.8（1.2-2.5；p=0.002）。按年龄分层后，HIV 感染与主要骨折之间的关联在年龄<59 岁的患者中减弱（调整 HR 1.35 [0.88-2.07]，p=0.17），但在年龄较大的患者中则更为明显（调整 HR 2.11 [1.05-4.22]，p=0.035）。我们报告了 HIV 感染与髋部骨折发生率之间的强烈关联，感染 HIV 的患者风险增加近五倍，与性别、年龄、吸烟、饮酒和合并症无关。同样，我们发现诊断为 HIV 感染的患者的所有临床骨折风险增加 75%，非髋部临床骨折风险增加 60%。
