POS0067 COMPARATIVE ANALYSIS OF JAW OSTEONECROSIS IN BISPHOSPHONATE-TREATED PATIENTS WITH OSTEOPOROSIS: IMPACT OF HIV STATUS - A RETROSPECTIVE OBSERVATIONAL STUDY
Authors: I. Tskhakaia, R. Ali, F. Rodriguez
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> The rising life expectancy in People Living with HIV (PLWH) parallels that of the HIV-uninfected, leading to increased age-related conditions like osteoporosis. PLWH face a higher fracture risk, occurring a decade earlier than the general population. Though FRAX underestimates fracture risk in PLWH, bisphosphonates are the most commonly prescribed medication. Early calcium, vitamin D supplementation, and bone-protective Antiretroviral therapy (ART) regimens show promise in mitigating bone loss. Osteoporosis and jaw osteonecrosis are critical concerns due to HIV and certain ART contributing to increased bone fragility. While bisphosphonates offer benefits in osteoporosis treatment, their use in HIV contexts presents potential risks. <h3>Objectives:</h3> This retrospective, observational study investigates the occurrence of ONJ in HIV-positive patients receiving bisphosphonate therapy compared to non-HIV individuals on similar treatment regimens. Exploring the comparative risks of ONJ in these populations contributes to a deeper understanding of bone health management in HIV-infected patients undergoing bisphosphonate therapy. <h3>Methods:</h3> This study targeted individuals aged 18 and older diagnosed with osteoporosis, with or without current pathological fractures, identified via International Classification of Diseases, Tenth Revision (ICD-10) codes. Spanning from January 1st, 2000, to December 14th, 2023, the analysis established two distinct cohorts: one with patients diagnosed with both HIV and osteoporosis, receiving bisphosphonate treatments (Alendronate, Risedronate, Zoledronic acid, or Ibandronate), and another cohort consisting of individuals solely diagnosed with osteoporosis, undergoing identical treatment but lacking an HIV diagnosis. The 'index event' marked the initial occurrence of both HIV and osteoporosis diagnoses along with corresponding medication in patient records. Exclusion criteria comprised patients with bone neoplasms, steroid use, erythropoietin, H2 blocker, sunitinib, or bevacizumab use. Propensity score matching ensured cohort balance based on age, sex, race/ethnicity, circulatory system diseases, health influencing factors, neoplasms, and genitourinary diseases. Primary outcomes focused on jaw osteonecrosis incidence, identified by ICD-10 codes M87.08, M87.88, M87.180, excluding cases predating the index event. Analysis employed risk and risk ratio computation to investigate the potential association between HIV diagnosis and jaw osteonecrosis risk. <h3>Results:</h3> Initial analysis of 114,922 patients without an HIV diagnosis and 893 patients diagnosed with HIV revealed slight age disparities between the groups pre-matching. Predominantly, both cohorts consisted of over 70% white patients, although the HIV group notably comprised a higher proportion of black patients. Sex distribution leaned towards females in both groups. Moreover, the HIV cohort presented a higher percentage of cardiovascular, neoplastic, and genitourinary disorders (Table 1). Prior to propensity score matching, the findings indicated a heightened risk of jaw osteonecrosis among individuals in the HIV group (1.12%) compared to the non-HIV group (0.1%) with a relative risk (RR) of 10.9 (95% CI 5.8-20.8, p &lt;0.0001). Following propensity score matching, which included 889 patients from each group in the analysis, the results reaffirmed the elevated risk observed in the HIV cohort for jaw osteonecrosis (1.1% vs. 0%), with a calculated risk difference of 1.131% (95% CI 0.43-1.8%, p 0.0015). (Table 2). <h3>Conclusion:</h3> Our investigation reveals a notable association between HIV infection and an increased risk of jaw osteonecrosis among patients undergoing bisphosphonate therapy for osteoporosis. The elevated risk in the HIV group underscores the importance of vigilant monitoring and tailored management strategies for jaw health in HIV-infected individuals receiving bisphosphonate treatments. Our findings prompt further research to elucidate the mechanisms underpinning this association and guide the development of targeted interventions for mitigating jaw complications in this vulnerable population. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>