ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2017
Antiretrovirals, Fractures, and Osteonecrosis in a Large International HIV Cohort.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 42 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
42 citing papers in PubMed, 1 synthesis or guideline pooled it, 88 citations in OpenAlex.
- Bone fracture among people living with HIV: A systematic review and meta-regression of prevalence, incidence, and risk factors.PloS one · 2020Pooled it
- Changes in bone quality after switching from a TDF to a TAF based ART: A pilot randomized study.Frontiers in endocrinology · 2023Trial
- Bone changes with candidate PrEP regimens containing tenofovir disoproxil fumarate and/or maraviroc and/or emtricitabine in US men and women: HPTN 069/ACTG A5305.The Journal of antimicrobial chemotherapy · 2022Trial
- Emtricitabine and tenofovir alafenamide vs emtricitabine and tenofovir disoproxil fumarate for HIV pre-exposure prophylaxis (DISCOVER): primary results from a randomised, double-blind, multicentre, active-controlled, phase 3, non-inferiority trial.Lancet (London, England) · 2020Trial
- Case review of 3 patients with musculoskeletal manifestation of human immunodeficiency virus and highly active antiretroviral therapy in the form of osteopenia and insufficiency fractures.BJR case reports · 2026Review
- Association of a polygenic risk score with low trauma fractures in people with HIV - The swiss HIV cohort study.PloS one · 2026Article
- Incidence of frailty-related fracture among Medicaid beneficiaries living with HIV and cancer: A cohort study.PloS one · 2026Article
- Research progress of femoral head necrosis in HIV-infected patients.Annals of medicine · 2025Review
- Incidence of frailty-related fracture among Medicaid beneficiaries living with HIV and cancer: A cohort study.medRxiv : the preprint server for health sciences · 2025Article
- [Atraumatic necrosis of the femoral head].Orthopadie (Heidelberg, Germany) · 2025Review
- Humeral head avascular necrosis: etiology, diagnosis, and management.Clinics in shoulder and elbow · 2025Article
- Aseptic osteonecrosis of the jaw in a patient with HIV on tenofovir.Proceedings (Baylor University. Medical Center) · 2025Article
- Unilateral avascular necrosis of the right hip in an HIV patient with tearing of the rectus femoris and adductor longus muscles.BMJ case reports · 2024Article
- Osteonecrosis of the Femoral Head in People Living With Human Immunodeficiency Virus: A Micro-Computed Tomography Study.Open forum infectious diseases · 2024Article
- Association of a Polygenic Risk Score With Osteoporosis in People Living With HIV: The Swiss HIV Cohort Study.The Journal of infectious diseases · 2023Article
- Subtrochanteric Pathological Femur Fracture in an HIV-Positive Patient on Tenofovir-based antiretroviral therapy: A Case Report and Review of the Literature.Journal of orthopaedic case reports · 2023Article
- Osteoradionecrosis After Mandibulotomy and Marginal Mandibulectomy in Patients With Oral Cancer.Cureus · 2023Article
- Avascular Necrosis of Femoral Head-Overview and Current State of the Art.International journal of environmental research and public health · 2022Review
- Osteonecrosis of the Femoral Head: Update Article.Revista brasileira de ortopedia · 2022Article
- Osteonecrosis of the Femoral Head.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2022Article
Corrections and comments
- Erratum issuedErratum.2017
Authors and funding
23 authors at 20 institutions in 16 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAntiretrovirals (ARVs) affect bone density and turnover, but their effect on risk of fractures and osteonecrosis of the femoral head is less understood. We investigated if exposure to ARVs increases the risk of both bone outcomes.
methodsEuroSIDA participants were followed to assess fractures and osteonecrosis. Poisson regression identified clinical, laboratory and demographic predictors of either bone outcome. Ever, current, and cumulative exposures to ARVs were assessed.
resultsDuring 86118 PYFU among 11820 included persons (median age 41y, 75% male, median baseline CD4 440/mm3, 70.4% virologically suppressed), there were 619 fractures (incidence/1000 PYFU 7.2; 95% CI 6.6-7.7) and 89 osteonecrosis (1.0; 0.8-1.3). Older age, white race, lower BMI, IV drug use, lower baseline CD4, HCV coinfection, prior osteonecrosis, prior fracture, cardiovascular disease, and recent non-AIDS cancer (last 12 months) were associated with fractures. After adjustment, persons who had ever used tenofovir disoproxil fumarate (TDF) (1.40; 1.15-1.70) or who were currently on TDF (1.25; 1.05-1.49) had higher incidence of fractures. There was no association between cumulative exposure to TDF and fractures (1.08/5 y exposure; 0.94-1.25). No other ARV was associated with fractures (all P > .1). Risk of osteonecrosis was associated with white race, lower nadir CD4, prior osteonecrosis, prior fracture, and prior AIDS. After mutual adjustment, no ARV was associated with osteonecrosis.
conclusionsIn human immunodeficiency virus (HIV) infection, host factors, HIV-specific variables, and comorbidities contribute to risk of fractures and osteonecrosis. Exposure to TDF, but not other ARVs, was an independent risk factor for fractures.
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