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Updated: May 6, 2026
Measuring Frailty in HIV-infected Individuals. Identification of Frail Patients is the First Step to Amelioration and Reversal of Frailty
Published on: July 24, 2013
A cross-sectional randomised study of fracture risk in people with HIV infection in the probono 1 study
Barry S Peters1, Melissa Perry, Anthony S Wierzbicki
1Department of Infectious Diseases, Kings College London, London, United Kingdom ; Honorary Consultant Physician, Guys and St Thomas' Foundation Hospitals, London, United Kingdom.
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 <5% for all groups. RLFP was greater in patients with HIV (OR=1.22; p=0.003) and increased with ART (2.4 vs. 1.50; OR= 1.50; p=0.03).
Conclusions:
The increased fracture rate in HIV patients in our relatively youthful population is partly driven by fractures, including non-fragility fractures, in men. Nonetheless, these findings may herald a rise in osteoporotic fractures in HIV patients. An appropriate screening and management response is required to assess these risks and identify associated lifestyle factors that are also associated with other conditions such as cardiovascular disease and diabetes.
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