Bone fracture among people living with HIV: A systematic review and meta-regression of prevalence, incidence, and risk factors

Abstract

Introduction People living with HIV (PLWH) had a higher prevalence and incidence rate of bone fracture compared to general population. Although several studies have explored this phenomenon, the prevalence and incidence rate of fracture were varied. Objective The aim of the study is to determine and analyze the pooled prevalence, incidence rate of fracture and fracture risk factors among people living with HIV (PLWH). Methods PubMed, Cochrane Library, CINAHL with full Text, and Medline databases for studies published up to August 2019 were searched. Studies reporting the prevalence or incidence of fracture among PLWH were included. Study quality was assessed using the Joanna Briggs Institute (JBI) appraisal tool. A meta-analysis with random-effects model was performed to determine pooled estimates of prevalence and incidence rates of fracture. A meta-regression was performed to determine the source of heterogeneity. Results The pooled estimated prevalence of fracture among PLWH was 6.6% (95% CI: 3.8-11.1) with pooled odds ratio of 1.9 (95%CI: 1.1-3.2) compared to the general population. The pooled estimates of fracture incidence were 11.3 per 1000 person-years (95%

FRAX assessment in people ageing with HIV

“…Although FRAX is a screening tool developed to predict fracture risk, osteoporosis is a major risk factor for fractures and early diagnosis is crucial to provide lifestyle advice and pharmacological interventions in a timely manner. In line with previous studies that reported poor sensitivity of FRAX both in the general population and in PLWH [20,21], our results confirm that FRAX score should not be used as an only tool to define eligibility to perform DXA. Indeed, if FRAX is used alone, a substantial percentage of osteoporosis diagnoses may be missed.…”

Longitudinal Changes in Sex Hormone–Binding Globulin in Men With HIV

“…39 In addition, men with SHBG concentrations $66 nmol/L have been reported to have 3 times the odds of frailty compared with men with SHBG ,66 nmol/L. 38 Given that PWH have a higher prevalence of frailty and bone fracture compared with people without HIV, 41,42 the possibility that higher SHBG concentrations may impact these aging-related clinical conditions deserves further investigation.…”

Impact of hypogonadism on bone mineral density and vertebral fractures in HIV-infected men

“…Data on the impact of hypogonadism on fractures in HIV-infected men are more sparse [42], and very rarely hypogonadism was assessed. Among the few studies that evaluated the possible correlation between hypogonadism and fractures in HIV-infected patients, Borderi et al [25] found that hypogonadism was not associated with morphometric VFs.…”