Increasing doses of GCs were significantly associated with lower height and BMD Z-scores. A significant effect on growth was observed with cutoff doses above 0.2 mg/kg/day.
Summary We evaluated the influence of long-term HIV infection and its treatment on distal tibia and radius microstructure. Premenopausal eumenorrheic HIV-positive women displayed trabecular and cortical microstructure alterations, which could contribute to increased bone fragility in those patients. Introduction Bone fragility is an emerging issue in HIVinfected patients. Dual-energy X-ray absorptiometry (DXA) quantified areal bone mineral density (BMD) predicts fracture risk, but a significant proportion of fracture risk results from microstructural alterations. Methods We studied the influence of long-term HIV infection on bone microstructure as evaluated by high-resolution peripheral quantitative computed tomography (HR-pQCT) in 22 HIV-positive (+ve) premenopausal eumenorrheic women and 44 age-and body mass index (BMI)-matched HIV-negative (−ve) controls. All subjects completed questionnaires regarding calcium/protein intakes and physical activity, and underwent DXA and HR-pQCT examinations for BMD and peripheral skeleton microstructure, respectively. A risk factor analysis of tibia trabecular density using linear mixed models was conducted. Results In HIV+ve women on successful antiretroviral therapy (undetectable HIV-RNA, median CD4 cell count, 626), infection duration was 16.5±3.5 (mean ± SD)years; median BMI was 22 (IQR, 21-26)kg/m 2 . More HIV+ve women were smokers (82 versus 50 %, p00.013). Compared to controls, HIV+ve women had lower lumbar spine (spine T-score −0.70 vs −0.03, p00.014), but similar proximal femur BMD. At distal tibia, HIV+ve women had a 14.1 % lower trabecular density and a 13.2 % reduction in trabecular number compared to HIV−ve women (p00.013 and 0.029, respectively). HR-pQCT differences in distal radius were significant for cortical density (−3.0 %; p00.029). Conclusions Compared with HIV−ve subjects, premenopausal HIV+ve treated women had trabecular and cortical bone alterations. Adjusted analysis revealed that HIV status was the only determinant of between group tibia trabecular density differences. The latter could contribute to increased bone fragility in HIV+ve patients.
HIV-infected elderly men on successful ART have trabecular and cortical bone microstructure alterations associated with higher bone resorption, despite adequate vitamin D supplementation.
An automated diagnostic technique for early diagnosis of onset of osteoporosis is developed using cortical radiogrammetric measurements and cancellous texture analysis of hand and wrist radiographs. The work shows that a combination of cortical and cancellous features improves the diagnostic ability and is a promising low cost tool for early diagnosis of increased risk of osteoporosis.
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