{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T18:09:52Z","timestamp":1779386992394,"version":"3.53.1"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000048","name":"American Cancer Society","doi-asserted-by":"publisher","award":["RSG-18-147-01"],"award-info":[{"award-number":["RSG-18-147-01"]}],"id":[{"id":"10.13039\/100000048","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01CA250851"],"award-info":[{"award-number":["R01CA250851"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01AI170240"],"award-info":[{"award-number":["R01AI170240"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U01AI069918"],"award-info":[{"award-number":["U01AI069918"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P30CA006973"],"award-info":[{"award-number":["P30CA006973"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P30AI094189"],"award-info":[{"award-number":["P30AI094189"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01CA250851"],"award-info":[{"award-number":["R01CA250851"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01AI170240"],"award-info":[{"award-number":["R01AI170240"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P30AI094189"],"award-info":[{"award-number":["P30AI094189"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We included 14,554,711 beneficiaries without HIV and 159,188 beneficiaries with HIV who were 30\u201364 years old enrolled in Medicaid between 2001\u20132015 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u201344 Both: 1.24 95%CI:0.96,1.59; HIV: 0.74 95%CI:0.71,0.77; for ages 60\u201364 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0348898","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T17:23:15Z","timestamp":1779384195000},"page":"e0348898","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Incidence of frailty-related fracture among Medicaid beneficiaries living with HIV and cancer: A cohort study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4182-2868","authenticated-orcid":true,"given":"Xueer","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7177-1847","authenticated-orcid":true,"given":"Jacqueline E.","family":"Rudolph","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiyi","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoqiang","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keri L.","family":"Calkins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9056-0436","authenticated-orcid":true,"given":"Eryka L.","family":"Wentz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan","family":"Lau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5100-172X","authenticated-orcid":true,"given":"Corinne E.","family":"Joshu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"issue":"1","key":"pone.0348898.ref001","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1007\/s11657-021-00949-y","article-title":"Incident bone fracture and mortality in a large HIV cohort outpatient study, 2000-2017, USA","volume":"16","author":"L Battalora","year":"2021","journal-title":"Arch Osteoporos"},{"issue":"4","key":"pone.0348898.ref002","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1097\/QAI.0000000000003274","article-title":"Fracture risk and association with TDF use among people with HIV in large integrated health systems","volume":"94","author":"RC Hechter","year":"2023","journal-title":"Journal of acquired immune deficiency syndromes (1999)"},{"issue":"8","key":"pone.0348898.ref003","doi-asserted-by":"crossref","first-page":"1370","DOI":"10.1093\/cid\/ciy1101","article-title":"Frailty is an independent risk factor for mortality, cardiovascular disease, bone disease, and diabetes among aging adults with human immunodeficiency virus","volume":"69","author":"SG Kelly","year":"2019","journal-title":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America"},{"issue":"3","key":"pone.0348898.ref004","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1097\/QAD.0000000000002082","article-title":"Frailty predicts fractures among women with and at-risk for HIV","volume":"33","author":"A Sharma","year":"2019","journal-title":"AIDS"},{"issue":"1","key":"pone.0348898.ref005","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/QAI.0000000000002207","article-title":"Management of osteoporosis in patients living with HIV-A systematic review and meta-analysis","volume":"83","author":"J Starup-Linde","year":"2020","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"5","key":"pone.0348898.ref006","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1111\/hiv.13596","article-title":"HIV and fracture: Risk, assessment and intervention","volume":"25","author":"DM McGee","year":"2024","journal-title":"HIV Med"},{"issue":"6","key":"pone.0348898.ref007","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0233501","article-title":"Bone fracture among people living with HIV: A systematic review and meta-regression of prevalence, incidence, and risk factors","volume":"15","author":"I Pramukti","year":"2020","journal-title":"PLoS One"},{"issue":"4","key":"pone.0348898.ref008","doi-asserted-by":"crossref","DOI":"10.1093\/jnci\/dju503","article-title":"Excess cancers among HIV-infected people in the United States","volume":"107","author":"HA Robbins","year":"2015","journal-title":"J Natl Cancer 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