Geriatric nutritional risk index (GNRI) as a predictor of fragility fracture risk in older adults living with HIV: a 10-year retrospective longitudinal cohort study from China

Summary

This study reveals that the Geriatric Nutritional Risk Index (GNRI) is a strong predictor of fragility fracture risk in older adults living with HIV in China. Regular nutritional assessment using GNRI could identify high-risk individuals, potentially guiding interventions to reduce fracture risk in this vulnerable population.

Background

In China, a significant proportion of the PLWH are older adults, which differs from other regions. Malnutrition and fragility fractures are major concerns in this population. This study aimed to investigate the utility of the Geriatric Nutritional Risk Index (GNRI) as a predictor of fragility fracture risk in older adults living with HIV in China.

Methods

This retrospective longitudinal cohort study included older adults living with HIV (aged ≥ 50 years) from the Department of Orthopedics at Ditan Hospital in Beijing, China, between January 2010 and September 2023. Baseline GNRI scores were calculated using serum albumin, height, and weight, and patients were followed up for the occurrence of fragility fractures. Cox proportional hazards models were used to evaluate the association between GNRI and fragility fracture risk, adjusting for potential confounders.

Results

A total of 608 patients were included in the study (mean age: 60.3 years, 84.2% male). During the median 5-year follow-up period, 117 patients (19.2%) experienced fragility fractures. After adjusting for all potential covariates, patients with higher GNRI scores had a significantly lower risk of fragility fractures. The aHR for GNRI < 92 g/L was 3.28 (95% CI: 1.35–7.97, p = 0.009) compared to GNRI ≥ 92. RCS analysis revealed a significant inverse relationship between GNRI and fragility fracture risk, with the non-linearity diminishing after full adjustment for covariates.

Conclusion

The GNRI is a valuable tool for predicting fragility fracture risk in older adults living with HIV in China. Routine assessment of nutritional status using the GNRI could help identify high-risk individuals and guide appropriate interventions to reduce fragility fracture risk in this vulnerable population.