Femur Fracture Risk in HIV-Positive Patients with End Stage Renal Disease: A Comparative Analysis from 2004 2013 to 2014–2023

Abstract Background: While femur fractures typically affect the elderly, HIV-positive patients with end stage renal disease (ESRD) are at an accelerated risk due to prolonged antiretroviral therapy (ART) use and bone loss. The combined impact of these factors on fracture trends remains under-explored. Objective: To evaluate the association between femur fractures and the coexistence of HIV and ESRD, and to analyze trends in fracture incidence and prevalence from 2004–2013 to 2014–2023 by age, sex, and race. Methods: This retrospective cohort study used the TriNetX database to analyze data from 2,429 patients with HIV and ESRD receiving ART. The cohort was divided into two time periods: 2004 2013 and 2014–2023. Chi-square tests and Poisson regression were used to assess differences in fracture incidence and prevalence. Results: Femur fracture incidence increased from 1.52% to 2.61% (a 71% increase), while prevalence grew from 1.67% to 3.80% (a 127% increase). This rise was most pronounced in females, with incidence increasing from 1.53% to 3.24% versus 1.84% to 2.25% in males. Racial disparities were also observed, with incidence in Asian patients rising from 0.0% to 45.45% and in Black or African American patients from 1.42% to 2.1%. The increase in fractures was also evident in younger patients. Conclusion: The incidence of femur fractures in HIV-positive ESRD patients has significantly increased, with fractures occurring at earlier ages and disproportionately impacting women and certain racial minorities. These findings underscore the urgent need for early and routine bone health screening and tailored prevention strategies in this vulnerable population.