CROI 2016 Abstract eBook

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Poster Abstracts

698 Osteoporosis and Fractures in HIV-Infected Adults: Who Is Afraid of the Lumbar Spine? Linda A. Battalora 1 ; Kate Buchacz 2 ; Carl Armon 3 ; John Hammer 4 ; Joan S. Chmiel 5 ; John R. Spear 1 ; JohnT. Brooks 2 ; BenjaminYoung 6 ; EdgarT. Overton 7 ; for the HIV Outpatient Study (HOPS) and SUN Study Investigators 1 Colorado Sch of Mines, Golden, CO, USA; 2 CDC, Atlanta, GA, USA; 3 Cerner Corporation, Kansas City, MO, USA; 4 Denver Infectious Disease Consultants, Denver, CO, USA; 5 Feinberg Sch of Med, Northwestern Univ, Chicago, IL, USA; 6 Internatonal Association of Providers of AIDS Care, Washington, DC, USA; 7 Univ of Alabama at Birmingham, Birmingham, AL, USA Background: Although the World Health Organization recommends determining osteoporosis based on the bone mineral density (BMD) of the femoral neck, there are limited data comparing rates of osteoporosis based on assessment of the femoral neck versus lumbar spine among HIV-infected adults. Methods: We analyzed available dual energy X-ray absorptiometry (DXA) values of the hip (left femoral neck) and lumbar spine (L1-L4) and clinical data collected prospectively during 2004-2012 from two CDC-sponsored HIV cohort studies, the HOPS and the SUN Study. We identified patients with low BMD (osteopenia or osteoporosis, defined by T-scores of -1.0 to >-2.5, and ≤-2.5, respectively), at the femoral neck, lumbar spine, or both anatomical sites. Cox proportional hazards models were used to determine factors associated

with incident fracture using femoral neck, lumbar BMD, or both sites to determine osteoporosis. Results: Characteristics of 1000 patients with both femoral neck and lumbar spine BMD values were: median age 43 years (interquartile range [IQR] 36-49), 83%male, 67% non- Hispanic white, median CD4+ cell count [CD4] 461 cells/mm 3 [IQR 312-659]). During 4066 person-years (py) of observation after DXA during study, there were 85 incident fractures (20.9 per 1000py) including 22 fragility fractures (5.4 per 1000py). Prevalences of osteopenia and osteoporosis at the femoral neck only, lumbar spine only, and using the lower of the two BMD values were 35.5%, 30.6% and 44.0% and 3.7%, 7.1% and 8.4%, respectively. Among 71 patients with lumbar spine osteoporosis, 24 also had femoral neck osteoporosis. There was a direct linear association between femoral neck and lumbar spine BMD (Figure). Analyses of risk for fracture that defined osteoporosis based on using femoral neck BMD only, lumbar spine BMD only, and the lower of the two BMD values, respectively, identified the same risk factors: being a current or former tobacco smoker (aHR 1.64, 1.61 and 1.61, all P < 0.05) and the presence of osteoporosis (aHR 4.10, 3.17 and 3.01, all P < 0.001). Conclusions: In a large convenience sample of U.S. HIV-infected adults, adding lumbar spine data to osteoporosis assessment more than doubled diagnoses made with femoral neck data alone. Utilizing both anatomical sites expands the opportunity to identify persons at risk for fragility fractures and to intervene with therapies and recommend lifestyle changes to prevent fractures.

699 Fractures Occur at a Younger Age in HIV+Men in the Multicenter AIDS Cohort Study Anda R. Gonciulea 1 ; RuibinWang 2 ; Keri N. Althoff 2 ; Frank J. Palella 3 ; Jordan Lake 4 ; Lawrence Kingsley 5 ;ToddT. Brown 6 1 Johns Hopkins Univ Sch of Med, Baltimore, MD, USA; 2 Johns Hopkins Bloomberg Sch of PH, Baltimore, MD, USA; 3 Northwestern Univ, Chicago, IL, USA; 4 David Geffen Sch of Med at Univ of California Los Angeles, Los Angeles, CA, USA; 5 Univ of Pittsburgh, Pittsburgh, PA, USA; 6 Johns Hopkins Univ, Baltimore, MD, USA Background: Current guidelines recommend osteoporosis screening for HIV-infected men > 50 years old, but fracture data supporting this recommendation are limited. Methods: Between 1984 and 2014, self-reported bone fractures were ascertained at semi-annual visits in 1302 HIV-infected and 1302 HIV-uninfected men over age 40. The study outcomes were: 1) all fractures (excluding fractures of skull, face, digits) 2) fragility fractures (fractures of vertebral column, femur, wrist, humerus). Incidence rates per 1000 person-years (py), adjusted incident rate ratios (aIRR) and 95% confidence intervals [,] were estimated using Poisson regression with an interaction term for age (40-49, 50-59, ≥60 years) and HIV serostatus. Additional covariates included were race, body mass index (BMI), hypertension, diabetes, hepatitis C-coinfection, estimated glomerular filtration rate (eGFR), current smoking and alcohol use. Results: At index visit, HIV-infected and uninfected men were similar by age (median 40 years), BMI (median 25 kg/m 2 ), eGFR (median 103 vs 99 mL/min/1.73 m 2 ), alcohol use, presence of diabetes or hypertension. HIV-infected men were more likely to be hepatitis C virus infected (10% vs 6%, p<0.001), smokers (38% vs 31%, p<0.001) and non-white (41% vs 27%, p<0.001). Among HIV-infected men, fracture incidence rate was higher in 50-59 year-olds (yo) (IR=17.5 [14.2, 21.5]) compared to 40-49 yo (IR=8.3 [6.4, 10.6]), but was similar among uninfected men aged 50-59 yo (IR=8.7 [6.8, 11.1]) and 40-49 yo (IR=8.4 [6.6, 10.6]) (Figure). Compared to younger (age 40-49) uninfected men, 50-59 yo HIV-uninfected men had a similar rate (aIRR=1.02 [0.72, 1.44]) whereas ≥60 yo HIV-uninfected men had higher rate (aIRR=1.84 [1.29, 2.63]). Among HIV-infected men, the rate of incident fracture among 40-49 yo was similar to that observed among similarly aged HIV-uninfected men (aIRR=0.99 [0.7, 1.4]), but increased in 50-59 yo men (aIRR=1.99 [1.44, 2.74]) and ≥60 yo men (aIRR=1.88 [1.17, 3.01]). The incidence rate for osteoporotic fractures showed similar trends. Of all covariates, hypertension was consistently associated with an increased rate of all fractures (aIRR=1.33 [1.04, 1.71]). Conclusions: Bone fracture incidence increased with age among HIV-infected and uninfected men but was higher among HIV-infected men. A significant fracture increase was found among 50-59 yo HIV-infected men, highlighting the importance of osteoporosis screening in HIV infected men above the age of 50.

Poster Abstracts

290

CROI 2016