Low Trauma Fractures in People With HIV: Longitudinal Time Trends in the Swiss HIV Cohort Study, 2009-2022
Bone health remains a critical long-term concern for people living with HIV. Current guidelines indicate that this population faces an elevated risk of osteoporosis and low-trauma fractures (LTFs) compared to the general population.
This increased risk is attributed to factors including low body weight, vitamin D deficiency, hepatitis C virus (HCV) coinfection, smoking, substance use, chronic inflammation, and the toxicity of certain antiretroviral therapy (ART) agents. Consequently, early management of bone health is essential. Key strategies include periodic fracture risk assessment, promoting physical activity, ensuring adequate vitamin D and calcium intake, and selecting bone-sparing ART regimens.
This study analyzed time trends in LTFs and examined demographic, clinical, and HIV-related variables associated with bone health within the Swiss HIV Cohort Study (SHCS) from 2009 to 2022. Fractures were prospectively captured in the SHCS. Negative binomial regression was employed to estimate the LTF incidence rate ratio per calendar year, both univariably and adjusted for time-updated clinical and HIV-related risk factors, as well as a genome-wide polygenic risk score associated with bone mineral density.
The analysis included data from 7’524 SHCS participants, with 235 validated LTF records. Factors potentially associated with better bone health varied over the study period. A declining trend in LTF incidence was observed across men and women, age groups, and genetic backgrounds, regardless of whether the participants had a favorable or unfavorable polygenic risk profile.
In conclusion, the incidence of low-trauma fractures has decreased considerably among people living with HIV in Switzerland. This decline is likely multifactorial, driven by favorable trends in antiretroviral therapy, demographics, and lifestyle improvements that contribute to better bone health.