PCR analysis Real-time PCR was performed as described previously

le over the age of 70, whereas the National Hip Fracture Database in the UK reports the average age of a person with hip fracture as 84 years for men and 83 for women. Hence, the findings from our study might therefore herald a major problem for people with HIV as they approach their later decades of life. We found a three-fold increase in INK1117 DXA-defined osteoporosis in HIV infected versus uninfected people, and was similar to other studies. The relative risk and the absolute incidence of osteoporosis among HIV-infected subjects in the younger age groups were similar for males as for females. In contrast, for the group 55 years and older, we found that 58.3% of HIVinfected females had osteoporosis compared to only 8.3% of men. This may explain why a recent study comparing HIV infected versus uninfected women, showed no difference in fracture incidence 9405293 between the two groups, as most of the participants were pre- or peri-menopausal. The terms osteoporosis and osteopenia were not intended to be used clinically for people below 40 years and we did not advise these younger patients that they had any significant disease; conversely, we did address modifiable factors identified such as smoking, alcohol, and levels of daily activity. An HIV-specific FRAX score would be useful for management decisions but this will require a large and longterm observational study. The 10-year risk of fracture is usually low for our HIV patients, even though many have a high number of risk factors for fragility fracture. This is because most people with HIV are currently well below the age where fragility fractures are common. Over the coming decades, 6 Fracture Risk and HIV:Probono 1 Study fractures in people with HIV may represent an even greater cause of morbidity and mortality than for the high levels already seen among the general population. The lifetime risk of fractures among our cohort indicates the potential burden of such disease in the future, and may prompt us to avert these risks by means revised screening and management. There was a considerably greater risk of spine fracture among male and female HIV positive recruits than for the control group. At the hip and neck of femur for 6178174 HIV infected males, there was also a marked relative risk of lifetime fractures compared to controls, but for females the risks were similar at these two sites. These site specific findings may reflect the different composition of bone at the hip, which is mainly cortical in composition compared to the vertebrae which, although it has a cortical shell, is predominantly trabecular. Spine BMD measured by quantitative CT, which estimates trabecular bone only, is usually lower and declines faster than BMD estimated by DXA or those without PIs. There was no difference between those currently taking, or not taking, a tenofovir-containing regimen. It is unlikely that an ascertainment bias would have had a significant effect on this observation because during the study period drug regimens were not altered according to fracture risk. An increased relative risk of osteopenia and osteoporosis has been associated with the use of HAART in several, but not all studies, and an increase in fragility fractures with protease inhibitor drugs has been observed. There was an increase in fractures among those patients who remained on treatment in the Strategies for Management of Anti-Retroviral Therapy bone sub-study, compared to those who had a treatment interruption, although there were only a