Background: Patients with HIV infection can present or develop multiple comorbidities including potential risk factors for bone fractures. Some treatments are associated with bone mineral density (BMD) loss, and thus HIV patients initiating antiretroviral therapy (ART) may be at increased risk for fractures. The objective of this study was to describe rates of fracture among HIV patients in the US.
Methods: Adults diagnosed with HIV (ICD-9 code: 042.xx, 795.71, V08) in 2007-2013 were selected from MarketScan Commercial, Medicare, and Medicaid Databases. Patients were continuously enrolled for ≥ 365 days in 2007-2013. HIV patients were analyzed by presence of prior fracture. In each calendar year, prevalence and incidence rates of fracture (excluding traumatic fracture) and use of steroid were examined.
Results: A total of 37,639 HIV patients were examined from the Commercial (N=31,229; mean age: 42.8; male: 77.9%), Medicare (N=1,541; mean age: 71.9; male: 62.7%), and Medicaid (N=10,190; mean age: 42.9; male: 44.1%) databases. In 2007-2013, fracture prevalence (per 1,000 persons) and incidence rates (per 1000 person-years) were, respectively, 83.1 and 22.1 in Commercial, 263.5 and 63.9 in Medicare, and 191.2 and 42.5 in Medicaid. Prevalence rates have increased over time in each cohort. Patients had evidence of prior fracture (Commercial: 7.5%, Medicare: 23.6%, Medicaid: 15.2%) and history of use of steroid (54.8%, 64.7%, 61.0%).
Conclusion: We observed an increase in fracture prevalence over time in HIV-infected persons. Because of the potential effects of ART treatment on BMD observed in published data, understanding risk factors for fracture in HIV patients may be important in optimizing treatment choices.
X. Song, None