Fisher, M

Gilleece, Y

Malik, R

Samarawickrama, A

Walker-Bone, K

English

PubMed

A Samarawickrama

R Malik

M Fisher

Y Gilleece

K Walker-Bone

Springer - Publisher Connector

POSTER PRESENTATION Open Access
Rates of bone fractures in a cohort of HIV-
infected adults in the UK
A Samarawickrama1*, R Malik2, M Fisher1, Y Gilleece1, K Walker-Bone3
From Tenth International Congress on Drug Therapy in HIV Infection
Glasgow, UK. 7-11 November 2010
Purpose of study
With combination antiretroviral therapy (cART), HIV-
associated mortality rates have declined substantially in
the UK. However HIV-infected adults are living longer
to develop co-morbidities, including low bone mineral
density (BMD). This study investigates fractures in a UK
cohort of HIV-infected adults.
Methods
A cross-sectional survey of 1050 HIV-infected adults
from routine HIV clinics was conducted. Subjects
completed a questionnaire about demography, lifestyle
factors, fracture history and management, exposure to
glucocorticoids and other drugs influencing bone meta-
bolism. HIV details (duration and route of infection, dis-
ease stage, cART exposure and parameters of viral
control) were recorded.
Results
There were 859 useable replies (response rate 82%) from
775 men and 84 women: mean age 43 years (range
19-77 years) and 87% Caucasian. Mean duration of HIV
infection was 8 years (range 0-23 years). Co-infection
with hepatitis B occurred in 16 subjects and hepatitis C
in 11. Overall, 125 (15%) subjects reported 200 fractures:
119 (15%) men and 6 (7%) women. Common fracture
sites were forearm (n=65), tibia/fibula (n=29), hand/foot
(n=22) and digit (n=19). Hip fractures occurred in 6
subjects and 2 had clinical vertebral fractures. A bimo-
dal distribution of fracture was seen: 114 (57%) fractures
occurred in subjects <25 years (peak age 7-12 years) and
33 (17%) fractures in those >40 years, with 8 (24%) in
subjects >50 years. Among subjects >40 years with frac-
tures (30 men and 3 women; 32 Caucasian), common
fracture sites were forearm (n=6, mean age 48 years)
and tibia/fibula (n=4, mean age 49 years); there was 1
hip fracture (age 46 years). 15% of these subjects
reported oral glucocorticoid exposure (vs. 9% without
fractures (p=ns)) and 79% had ever smoked (vs. 72%
without fractures (p=ns)).
Conclusions
This is the first epidemiological study of fractures in
HIV-infected adults in the UK. There were 2 peaks of
fracture incidence: <25 years and 40-60 years. Forearm
fractures were the commonest but fractures at other
‘typical’ osteoporotic sites (vertebral and hip) were seen.
The second peak occurred at a younger age than those
reported in HIV-negative subjects. This is consistent
with data showing accelerated immune senescence in
HIV. Although the clinical importance of low BMD is
yet to be fully evaluated, if fracture rates are increased,
routine assessment of low BMD and fracture risk may
be warranted in this relatively young population.
Author details
1Brighton and Sussex University Hospitals, Department of HIV and
Genitourinary Medicine, Brighton, UK. 2Brighton and Sussex University
Hospitals, Department of Rheumatology, Brighton, UK. 3Brighton and Sussex
Medical School, Department of Infection and Inflammation, Brighton, UK.
Published: 8 November 2010
doi:10.1186/1758-2652-13-S4-P100
Cite this article as: Samarawickrama et al.: Rates of bone fractures in a
cohort of HIV-infected adults in the UK. Journal of the International AIDS
Society 2010 13(Suppl 4):P100.
1Brighton and Sussex University Hospitals, Department of HIV and
Genitourinary Medicine, Brighton, UK
Full list of author information is available at the end of the article
Samarawickrama et al. Journal of the International AIDS Society 2010, 13(Suppl 4):P100
http://www.jiasociety.org/content/13/S4/P100
© 2010 Samarawickrama et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.


Rates of bone fractures in a cohort of HIV-infected adults in the UK

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Journal of the International AIDS Society

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Rates of bone fractures in a cohort of HIV-infected adults in the UK

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