Anjali Sharma1, Qiuhu Shi2, Donald R Hoover3, Phyllis C Tien4,5, Michael W Plankey6, Mardge H Cohen7, Elizabeth T Golub8, Deborah Gustafson9, Michael T Yin10. 1. Department of Medicine, Albert Einstein College of Medicine, Bronx. 2. Department of Epidemiology and Community Health, New York Medical College, Valhalla, New York. 3. Department of Statistics and Biostatistics, Rutgers University, Piscataway, New Jersey. 4. Division of Infectious Diseases, University of California, San Francisco. 5. Division of Infectious Diseases, San Francisco Veterans Affairs Medical Center, San Francisco, California. 6. Department of Medicine, Georgetown University School of Medicine, Washington, District of Columbia. 7. Departments of Medicine, Stroger (Formerly Cook County) Hospital and Rush University, Chicago, Illinois. 8. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 9. Department of Neurology, State University of New York Downstate Medical Center, Brooklyn. 10. Division of Infectious Diseases, Columbia University Medical Center, New York, New York, USA.
Abstract
OBJECTIVE: To determine associations between frailty and fracture in women with and without HIV infection. DESIGN: Prospective longitudinal cohort study evaluating associations between baseline frailty status and frailty components, with first and second incident fractures. METHODS: We evaluated associations of frailty with fracture among 1332 women with HIV and 532 uninfected women without HIV. Frailty was defined as at least three of five Fried Frailty Index components: slow gait, reduced grip strength, exhaustion, unintentional weight loss, and low physical activity. Cox proportional hazards models determined predictors of time to first and second fracture; similar models evaluated Fried Frailty Index components. RESULTS: Women with HIV were older (median 42 vs. 39 years, P < 0.0001) and more often frail (14 vs. 8%, P = 0.04) than women without HIV; median follow-up was 10.6 years. Frailty was independently associated with time to first fracture in women with and without HIV combined [adjusted hazard ratio (aHR) 1.71, 95% confidence interval (CI): 1.30-2.26; P = 0.0001], and among women with HIV only (aHR 1.91, 95% CI: 1.41-2.58; P < 0.0001), as well as with time from first to second fracture among women with HIV (aHR 1.86, 95% CI: 1.15-3.01; P = 0.01). CONCLUSION: In this cohort of middle-aged racial and ethnic minority women with or at-risk for HIV, frailty was a strong and independent predictor of fracture risk. As women with HIV continue to age, early frailty screening may be a useful clinical tool to help identify those at greatest risk of fracture.
OBJECTIVE: To determine associations between frailty and fracture in women with and without HIV infection. DESIGN: Prospective longitudinal cohort study evaluating associations between baseline frailty status and frailty components, with first and second incident fractures. METHODS: We evaluated associations of frailty with fracture among 1332 women with HIV and 532 uninfected women without HIV. Frailty was defined as at least three of five Fried Frailty Index components: slow gait, reduced grip strength, exhaustion, unintentional weight loss, and low physical activity. Cox proportional hazards models determined predictors of time to first and second fracture; similar models evaluated Fried Frailty Index components. RESULTS: Women with HIV were older (median 42 vs. 39 years, P < 0.0001) and more often frail (14 vs. 8%, P = 0.04) than women without HIV; median follow-up was 10.6 years. Frailty was independently associated with time to first fracture in women with and without HIV combined [adjusted hazard ratio (aHR) 1.71, 95% confidence interval (CI): 1.30-2.26; P = 0.0001], and among women with HIV only (aHR 1.91, 95% CI: 1.41-2.58; P < 0.0001), as well as with time from first to second fracture among women with HIV (aHR 1.86, 95% CI: 1.15-3.01; P = 0.01). CONCLUSION: In this cohort of middle-aged racial and ethnic minority women with or at-risk for HIV, frailty was a strong and independent predictor of fracture risk. As women with HIV continue to age, early frailty screening may be a useful clinical tool to help identify those at greatest risk of fracture.
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