Michael T Yin1, Donald R Hoover2, Qiuhu Shi3, Phyllis C Tien4,5, Mardge H Cohen6, Seble Kassaye7, Deborah Gustafson8, Adaora Adimora9, M Neale Weitzmann10,11, Hector Bolivar12, Amy Warriner13, Sara H Bares14, Anjali Sharma15. 1. Department of Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY. 2. Department of Statistics and Institute for Health, Healthcare Policy and Aging Research, Rutgers University, Piscataway, NJ. 3. School of Health Sciences and Practice, New York Medical College, Valhalla, NY. 4. Department of Veterans Affairs Medical Center. 5. Department of Medicine, University of California San Francisco, San Francisco, CA. 6. Department of Medicine, Stroger Hospital, Chicago, IL. 7. Georgetown School of Medicine, Washington DC. 8. State University of New York Downstate Medical Center, Brooklyn, NY. 9. Department of Medicine, University of North Carolina School of Medicine, Chapel Hill. 10. Department of Medicine, Emory University School of Medicine, Atlanta. 11. the Atlanta VA Medical Center, Decatur, GA. 12. Department of Medicine, University of Miami, Miami, FL. 13. Department of Medicine, University of Alabama, Birmingham AL. 14. Department of Medicine, University of Nebraska Medical Center, Omaha, NE. 15. Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
Abstract
BACKGROUND: Fracture rates have been reported to be higher among older women living with HIV (WLWH) than HIV- women. Hormone therapy with estrogen can reduce vasomotor symptoms (VMS) associated with menopause and prevent fractures. As data are limited on the benefits of hormone therapy use in WLWH, we examined associations of hormone therapy, use and fractures. METHODS: A prospective study of 1765 (1350 WLWH and 415 HIV-) postmenopausal Women's Interagency HIV Study (WIHS) participants was performed, including self-reported hormone therapy, use and fracture data from 2003 to 2017. Proportional hazard models determined predictors of new fractures at any site or at typical fragility fracture sites (hip, spine, wrist). RESULTS: At the first postmenopausal visit, the median (IQR) age of WLWH was slightly younger than HIV- women [49.8 (46.4-53) vs. 50.7 (47.5-54), P = 0.0002] and a smaller proportion of WLWH reported presence of VMS (17% vs. 26%, P < 0.0001). A greater proportion of WLWH than HIV- women reported hormone therapy use (8% vs. 4%, P = 0.007) at the first postmenopausal visit. In multivariate analyses, white race and smoking were significant predictors of incident fracture at any site but hormone therapy ( P = 0.69) and HIV status ( P = 0.53) were not. CONCLUSION: Our study did not find evidence of benefit or harm with regards to fracture outcomes in postmenopausal WLWH receiving hormone therapy. Further research is needed to determine whether hormone therapy has benefits beyond treatment of VMS, such as prevention of adverse aging-associated outcomes.
BACKGROUND: Fracture rates have been reported to be higher among older women living with HIV (WLWH) than HIV- women. Hormone therapy with estrogen can reduce vasomotor symptoms (VMS) associated with menopause and prevent fractures. As data are limited on the benefits of hormone therapy use in WLWH, we examined associations of hormone therapy, use and fractures. METHODS: A prospective study of 1765 (1350 WLWH and 415 HIV-) postmenopausal Women's Interagency HIV Study (WIHS) participants was performed, including self-reported hormone therapy, use and fracture data from 2003 to 2017. Proportional hazard models determined predictors of new fractures at any site or at typical fragility fracture sites (hip, spine, wrist). RESULTS: At the first postmenopausal visit, the median (IQR) age of WLWH was slightly younger than HIV- women [49.8 (46.4-53) vs. 50.7 (47.5-54), P = 0.0002] and a smaller proportion of WLWH reported presence of VMS (17% vs. 26%, P < 0.0001). A greater proportion of WLWH than HIV- women reported hormone therapy use (8% vs. 4%, P = 0.007) at the first postmenopausal visit. In multivariate analyses, white race and smoking were significant predictors of incident fracture at any site but hormone therapy ( P = 0.69) and HIV status ( P = 0.53) were not. CONCLUSION: Our study did not find evidence of benefit or harm with regards to fracture outcomes in postmenopausal WLWH receiving hormone therapy. Further research is needed to determine whether hormone therapy has benefits beyond treatment of VMS, such as prevention of adverse aging-associated outcomes.
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