Incidence of frailty-related fracture among Medicaid beneficiaries living with HIV and cancer: A cohort study

BACKGROUND: People living with HIV (PLWH) are at increased risk for frailty-related fracture. Limited evidence suggests recent diagnosis of non-AIDS defining cancer (NADC) is a risk factor for fracture among PLWH. We evaluated frailty-related fracture by HIV and cancer status to inform the burden of fracture among PLWH. METHODS: We included 14,554,711 beneficiaries without HIV and 159,188 beneficiaries with HIV who were 30-64 years old enrolled in Medicaid between 2001-2015 in 14 states. HIV, NADC, and fracture diagnoses were identified from inpatient and other non-prescription claims. We calculated age-specific fracture incidence per 100 person-years and 95% confidence intervals for beneficiaries with no NADC or HIV, NADC only, HIV only, or both. We estimated the cumulative incidence of frailty-related fracture with death as a competing event for each group. RESULTS: Fracture incidence increased with age in all groups. Compared to beneficiaries without NADC or HIV, all groups had significantly higher age-specific incidence of fracture. Beneficiaries with HIV and NADC had higher incidence of frailty-related fracture than those with HIV only at all ages (Incidence per 100 person-years for ages 30-44 Both: 1.24 95%CI:0.96,1.59; HIV: 0.74 95%CI:0.71,0.77; for ages 60-64 Both: 2.11 95%CI:1.64,2.67; HIV: 1.47 95%CI:1.37,1.58). Conversely, cumulative incidence was lowest for both HIV and NADC, likely due to in part to the very high incidence of death. CONCLUSION: Beneficiaries with HIV and NADC had higher age-specific frailty-related fracture and death than beneficiaries with HIV alone. Future work should investigate fracture risk among PLWH with cancer to inform interventions for fracture prevention.