A cross-sectional randomised study of fracture risk in people with HIV infection in the probono 1 study.

OBJECTIVE:To determine comparative fracture risk in HIV patients compared with uninfected controls. DESIGN:A randomised cross-sectional study assessing bone mineral density (BMD), fracture history and risk factors in the 2 groups. SETTING:Hospital Outpatients. SUBBBJECTS:222 HIV infected patients and an equal number of age-matched controls. ASSESSMENTS:Fracture risk factors were assessed and biochemical, endocrine and bone markers measured. BMD was assessed at hip and spine. 10-year fracture probability (FRAX) and remaining lifetime fracture probability (RFLP) were calculated. MAIN OUTCOME MEASURES:BMD, and history of fractures. RESULTS:Reported fractures occurred more frequently in HIV than controls, (45 vs. 16; 20.3 vs. 7%; OR=3.27; p=0.0001), and unsurprisingly in this age range, non-fragility fractures in men substantially contributed to this increase. Osteoporosis was more prevalent in patients with HIV (17.6% vs. 3.6%, p<0.0001). BMD was most reduced, and predicted fracture rates most increased, at the spine. Low BMD was associated with antiretroviral therapy (ART), low body mass index and PTH. 10-year FRAX risk was