LAUSR

Objectives: To determine the incidence of fracture among aging HIV-infected (HIV+) and uninfected men (HIV−). To evaluate factors independently associated with fracture risk. Design: Prospective, multicenter cohort study of men with or at risk for HIV. Methods: Outcome measures: all fractures (excluding skull, face and digits) and fragility fractures (vertebral column, femur, wrist and humerus) were collected semiannually in 1221 HIV+ and 1408 HIV− men aged at least 40. Adjusted incident rate ratios (aIRR) with an interaction term for age (40–49, 50–59 and ≥60 years) and HIV serostatus were estimated with Poisson regression models accounting for additional risk factors. Results: Fracture incidence increased with age among both HIV+ and HIV− men. Although there was no significant difference in fracture incidence by HIV serostatus among men aged 40–49 years, the HIV+ men aged 50–59 years had a significantly higher incidence of all fractures [aIRR: 2.06 (1.49, 2.84)] and fragility fractures [aIRR: 2.06 (1.21, 3.50)] compared with HIV− participants of similar age. HIV modified the effect of age on all fractures (P = 0.002) but did not significantly modify the effect for fragility fractures (P = 0.135). Hypertension increased the rate of all fractures by 32% after adjustment for covariates [aIRR: 1.32 (1.04, 1.69)]. Conclusion: Fracture incidence increased with age among HIV+ and HIV− men but was higher among HIV+ men. A significant increase in fracture incidence was found among 50–59-year-old HIV+ men, highlighting the importance of osteoporosis screening for HIV-infected men above the age of 50.