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Proteinuria Is Associated With Increased Risk of Fragility Fracture in Men With or at Risk of HIV Infection.

ABSTRACT: BACKGROUND:Proteinuria has been associated with bone loss and fractures in general population, but data in HIV-infected population are lacking. SETTING:Prospective, multicenter cohort study of men with or at risk of HIV infection. METHODS:Between 2006 and 2015, urine protein measurements and bone fracture histories were ascertained semiannually in 947 HIV-infected (HIV+) and 969 HIV-uninfected (HIV-) men aged 40 years or older. Proteinuria was defined as protein-to-creatinine ratio ?200 mg/g at ?2 consecutive visits. Outcome measures (1) all fractures (excluding fractures of skull, face, and digits) and (2) fragility fractures (fractures of vertebral column, femur, wrist, and humerus). Multivariable Cox proportional hazards models assessed the association between proteinuria and fracture after adjusting for additional risk factors. RESULTS:The overall period prevalence of proteinuria was higher among HIV+ than HIV- (29% vs 6%, P < 0.001). Men with proteinuria had a significantly higher risk of fragility fracture compared with men without proteinuria [adjusted hazard ratio (aHR) = 2.29 (1.12-4.66)] and did not differ by HIV serostatus (p-interaction = 0.83). The risk of all fractures was not statistically different between men with or without proteinuria [aHR = 1.31 (0.84-2.05)]. Among HIV+ men, the association between confirmed proteinuria and fragility fracture was attenuated [aHR = 2.12 (0.95-4.73)] after additional adjustment for CD4 T-cell count/mm, history of AIDS, the presence of detectable plasma HIV-1 RNA, and cumulative exposure to tenofovir disoproxil fumarate. CONCLUSIONS:Proteinuria was more common in HIV+ than in HIV- men and was a strong independent risk factor for fragility fracture regardless of HIV serostatus. Proteinuria should prompt consideration of a thorough evaluation for bone disease among HIV+ persons.

SUBMITTER: Gonciulea A

PROVIDER: S-EPMC6565496 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Proteinuria Is Associated With Increased Risk of Fragility Fracture in Men With or at Risk of HIV Infection.

Gonciulea Anda A Wang Ruibin R Althoff Keri N KN Estrella Michelle M MM Sellmeyer Deborah E DE Palella Frank J FJ Lake Jordan E JE Kingsley Lawrence A LA Brown Todd T TT

Journal of acquired immune deficiency syndromes (1999) 20190701 3

<h4>Background</h4>Proteinuria has been associated with bone loss and fractures in general population, but data in HIV-infected population are lacking.<h4>Setting</h4>Prospective, multicenter cohort study of men with or at risk of HIV infection.<h4>Methods</h4>Between 2006 and 2015, urine protein measurements and bone fracture histories were ascertained semiannually in 947 HIV-infected (HIV+) and 969 HIV-uninfected (HIV-) men aged 40 years or older. Proteinuria was defined as protein-to-creatini ...[more]

PMID: 30939529

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Project description:Two scoping reviews were conducted to review recommendations and guidelines for communication regarding general health risk, and to investigate communication strategies regarding risk of fracture. Healthcare professionals are invited to apply these recommendations to optimize a patient-centered approach to reducing risk of fracture.IntroductionTo conduct a scoping review of the medical literature regarding recommendations and tools for effective communication between healthcare professionals and patients regarding general health risk and risk of fracture.MethodsThe scoping review was divided into two parts to search for (1) studies presenting recommendations and guidelines for communication regarding general health risk; (2) studies investigating communication regarding risk of fracture for individuals at risk for fractures. Medline was searched in April 2020 to identify relevant studies.ResultsThe scoping review included 43 studies on communication with regard to general health risk and 25 studies about communication regarding risk of fracture. Recommendations for effective communication with regard to risk are presented. Communication of numeric data on risk should be adapted to the literacy and numeracy levels of the individual patient. Patient understanding of numerical data can be enhanced with appropriate use of visual aids (e.g., pie charts, icon arrays, bar charts, pictograms). The FRAX® tool is the most recommended and most used tool for assessing risk of fracture. Communication sent as individualized letters to patients following DXA scans has been studied, although patient understanding of their risk of fracture is often reported as low using this technique. Use of visual aids may improve patient understanding.ConclusionHealthcare professionals are encouraged to apply recommendations presented in this scoping review in their clinical practice. Patient understanding of risk of fracture should be confirmed by making sure that patients feel free to ask questions and express their concerns. This will contribute to an optimal patient-centered approach. Developing online tools to convert the probability of fracture into patient-friendly visual presentations could facilitate communication between healthcare professionals and patients about risk of fracture.

Dataset Information

Proteinuria Is Associated With Increased Risk of Fragility Fracture in Men With or at Risk of HIV Infection.

Publications

Proteinuria Is Associated With Increased Risk of Fragility Fracture in Men With or at Risk of HIV Infection.

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