According to a systemic review and meta-analysis, the prevalence of vertebral fractures is significantly increased in HIV-positive patients, regardless of age or gender. The study findings were presented at the American Society for Bone and Mineral Research (ASBMR)

Dr Premaor said, "Clinicians should be aware of this information, and the necessity of a spine X-ray in these subjects should be discussed with the health providers."

"Unprecedented" Rates of Fractures in Men in Their 40s and 50s

To better understand the effects, Dr Premaor and colleagues conducted a systemic review and meta-analysis of randomized controlled trials, cohort, cross-sectional, and other studies evaluating either morphometric or clinical vertebral fractures in patients who were HIV-positive, with or without treatment with ART.

The analysis showed that out of 26 studies included in the review, the odds ratio (OR) for vertebral fractures in HIV-positive patients compared with HIV-negative patients was 2.3 (95% CI, 1.37–3.85).

In 14 studies, involving 10,593 HIV-positive (ages 31 to 72), the prevalence of all vertebral fractures was 12.7%, with the prevalence of clinical vertebral fractures at 3.9% and the prevalence of morphometric vertebral fracture at 21.1%.

A meta-regression analysis showed no association between age or gender in the prevalence of vertebral fracture, and importantly, the age range was from 40 to 58. 

The total incidence of vertebral fracture per 1000 persons per year was 0.8 (95% CI, 0.4–1.8). The higher fracture rates seen with HIV could be the result of either the HIV virus itself or the medications used to treat it, Dr Premaor speculated.

"It's probably both," she said. "The early antiretrovirals, such as tenofovir, have a deleterious effect on bone. "In addition, some of these subjects have vitamin D deficiency, hypogonadism, and other risk factors for fractures, and the HIV itself might play a role. And we could not rule out unknown mechanisms."

Steven R Cummings said, "We have very little data on how much risk there is for fracture in people with HIV." "We know they have an increased risk of hip fractures, and this study shows there is also an increased risk of vertebral fractures."

The prevalence rate of fractures observed in people with HIV is remarkable, he added. "To see a prevalence rate of morphometric fractures that is that high is unprecedented in that age group — you don't see those rates except in women over the age of 65," he stressed.

"And the fact that the majority of the subjects are men is even more striking. This level of risk, if it is accurate, would certainly make it worthwhile for men in their 40s and 50s with HIV to get an X-ray of their spine." Dr Cummings noted, however, that the incidence rate of just 0.8 (per 1000 patient-years) appears inconsistent with the higher prevalence rates.

"We believe the quality of the reporting of the incidence of vertebral fracture was not as good, and we believe it is likely" a great underestimate, Dr Premaor responded. Additional research presented at the meeting further describes the effects of HIV on bone health.