In the present study, Schoepf et al investigated time trends of low trauma fractures in people with HIV. The authors benefited from the standardized data collection on fractures in the SHCS, which is implemented since 2008. They estimated low trauma fractures incidence rates per calendar year from 2009 to 2022 and adjusted for clinical and HIV-related risk factors including a genome-wide polygenic risk score associated with bone mineral density.
The study involves 7524 participants from the SHCS of whom 235 suffered low trauma fractures during the study period. Approximately half of the fractures reported were spine fractures, but the study included fractures from all body sites. The low trauma fracture incidence declined from 0.63 per 100 participant-years in 2009 to 0.13 per 100 participant-years in 2022. This represents a decline of 7.5% per calendar year (adjusted incidence rate). Interestingly, BMI and use of vitamin D, calcium and bisphosphonates increased during the study period, whereas smoking and exposure to tenofovir disoproxil fumarate (TDF) and boosted protease inhibitors (bPI) decreased.
Although the incidence rates were higher in females compared to males throughout the study period, incidence rates decreased for both female and male participants. Similarly, predicted incidence rates also decreased in both younger and older participants, as well as those with favorable and unfavorable genetic background regarding bone health according to a polygenic risk score. The observation of less low trauma fractures in persons with HIV is especially interesting as the cohort population has been aging during the study period. As no single explanatory factor for the observation has been identified, the decreasing incidence is likely due to multiple factors including demographic changes (fewer injection drug users, fewer participants who are underweight), medication changes (less prescription of TDF, bPI and corticosteroids) but also increasing well-controlled HIV infection, less smoking and increased physical activity.
In conclusion, the authors showed a decrease in the incidence of low trauma fractures among people with HIV over 14 years despite an aging cohort population. The decline observes is most likely multifactorial.