HIV-Positive ESRD Patients: A Decade Comparison of Femur and Hip Fracture Risk (2004-2013 vs. 2014-2023)

Introduction

HIV-positive patients with end-stage renal disease (ESRD) are at significantly increased risk for hip and femur fractures due to a combination of accelerated bone loss from both HIV and antiretroviral therapy (ART), particularly tenofovir disoproxil fumarate (TDF), which is known to reduce bone mineral density (BMD). Despite improvements in ART leading to longer life expectancy, prolonged exposure to these medications has raised concerns about earlier-onset osteoporosis and fractures in younger patients. This study evaluates trends in the incidence and prevalence of hip and femur fractures in HIV-positive ESRD patients across two decades (2004– 2013 vs. 2014–2023), with a specific focus on demographic differences in age, sex, and race.

Methods

This retrospective cohort study utilized data from the TriNetX database, which included 728,161 HIV-positive ESRD patients on ART from 2004 to 2023. The primary outcomes of interest were femur and hip fractures. Data on age, sex, and race were analyzed, and Poisson regression along with Chi-square tests were used to compare fracture rates between the two time periods (2004–2013 vs. 2014–2023).

Results

Femur fractures increased by 71% in incidence (1.52% to 2.61%) and 127% in prevalence (1.67% to 3.80%). Hip fractures showed a 184% rise in incidence (0.64% to 1.82%) and 248% in prevalence (0.69% to 2.40%). Significant increases in fracture rates were observed in younger age groups, particularly the 20–24 years group. Women experienced a larger increase in fracture rates (incidence 112%, prevalence 160%) compared to men. Racial disparities were evident, with Asians showing a notable rise in fracture incidence in the 2014–2023 period.

Conclusion

The incidence and prevalence of femur and hip fractures in HIV-positive ESRD patients have significantly increased over the past two decades. This rise is particularly notable in younger adults, women, and racial minorities, emphasizing a critical need for proactive measures to address bone health in this population. The findings suggest that fractures are occurring earlier, which highlights the importance of early osteoporosis screening, particularly for individuals on long-term ART. Given the severe consequences of fractures, including increased morbidity, mortality, and healthcare burden, early intervention strategies, such as DXA screening must be prioritized. These results underscore the urgent need for targeted fracture prevention, tailored interventions, and equitable healthcare strategies to mitigate bone health risks in HIV-positive ESRD patients.