BMD Is Reduced in HIV-Infected Men Irrespective of Treatment

Amiel, Corinne; Ostertag, Agnès; Slama, Laurence; Baudoin, Claude; Nguyen, Thu Huyen; Lajeunie, E; Neit-Ngeilh, L; Rozenbaum, Willy; Vernejoul, MC de

doi:10.1359/jbmr.0301246

Cited by 136 publications

(96 citation statements)

References 33 publications

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“…Available data on the role for HIV-related factors in bone loss among HIV-1-infected patients are conflicting [6]. Some studies have suggested that the use of protease inhibitor and of TDF was associated with an increased risk of osteopenia and osteoporosis [1,12,17,24,25] while others failed to confirm this association [18,20,26,27]. In the present study, neither protease inhibitors nor TDF was associated to bone loss with statistical significance, although weak trends of association were observed at several sites for TDF.…”

Section: Discussioncontrasting

confidence: 70%

Prevalence of Osteoporosis among HIV-1-Infected Men and Women Aged 50 years and Older in Dakar, Senegal: A Cross-Sectional Study

Cournil¹

2015

J AIDS Clin Res

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IntroductionA higher prevalence of low bone mineral density (BMD) and osteoporosis has been described in HIV-1-infected patients compared with HIV-uninfected subjects [1][2][3]. Recent data also suggest that HIV-1-infected people experience higher risks of osteoporosis-related fractures [4,5]. Several factors are involved in the pathogenesis of osteoporosis including traditional factors such as age, gender, low weight, current smoking, reduced physical activity, malnutrition and sex hormone deficiency; but also HIV infection specific risk factors and HIV treatment [6,7].Most studies have been conducted in North America (among both Caucasian and Black American people) and in Europe and bone status is poorly documented in patients living in Sub-Saharan Africa. We have previously reported that quantitative ultrasound (QUS) bone mineral density was lower in HIV-positive patients compared with negative controls from a cross-sectional study conducted in Dakar, Senegal [8]. However, in accordance with International Society Clinical Densitometry (ISCD) 2013 official positions, prevalence of osteoporosis could not be derived from QUS measures [9]. To date, information on osteoporosis among African populations is lacking. Several studies among HIV-positive and negative people reported higher bone mineral density, especially at femoral neck and total hip, as well as lower risk of fracture in African-American compared to Caucasians [10][11][12][13]. If these characteristics are also applied to Africans, it could be expected that HIV-1-infected patients living in sub-Saharan Africa would experience less osteoporosis. Conversely, patients living in resource-limited settings may be more affected by nutritional deficiencies and wasting which are known to be associated with low BMD [6,14].The aim of this cross-sectional study was to estimate the prevalence of osteoporosis based on dual energy X-absorptiometry (DXA) measurements of bone mineral density in Senegalese HIV-1-infected patients living in Dakar and to identify factors associated with osteoporosis in this population. The study focused on men and women aged over 50, for whom diagnosis of osteoporosis from DXA is fully applicable. Methods Study setting and patient populationFrom October, 2012 to February, 2013, a cross-sectional study was conducted at Fann University Hospital in Dakar. All HIV-1-infected AbstractBackground: Published studies reported a high prevalence of osteoporosis among HIV-1-infected subjects, but none of them were conducted in Sub-Saharan Africa. The objective was to estimate prevalence of osteoporosis based on dual energy X-absorptiometry bone mineral density in Senegalese patients above 50 years of age and to identify associated factors.

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Section: Discussioncontrasting

confidence: 70%

Prevalence of Osteoporosis among HIV-1-Infected Men and Women Aged 50 years and Older in Dakar, Senegal: A Cross-Sectional Study

Cournil¹

2015

J AIDS Clin Res

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“…In addition, antiretroviral treatment and mainly protease inhibitors are associated with reduced BMD, although the results of different studies are controversial [26,30,31]. Recently, the long-term adverse events from highly active antiretroviral therapy administration, especially lipid and glucose metabolism disorders, are studied, but the results are not consistent as well [32][33][34]. In our study, the exact mechanism for the more severe bone loss observed in the HIV-positive patients could not be explained by the measurement of bone markers, as we found no significant differences between HIV-positive and HIV-negative patients.…”

Section: Discussionmentioning

confidence: 99%

Increased bone resorption is implicated in the pathogenesis of bone loss in hemophiliacs: correlations with hemophilic arthropathy and HIV infection

et al. 2009

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International audienceOsteoporosis has been recently recognized as a severe comorbidity factor in hemophilia. However, its pathogenesis is still obscure. We evaluated the incidence of osteoporosis in 90 hemophilia patients and investigated possible correlations with clinical and laboratory data. Out of the 90 patients, 80 (89%) had severe hemophilia, and 35 (38.9%) were human immunodeficiency virus (HIV)-positive. Hemophilic arthropahty was assessed using World Federation of Hemophilia clinical score and Petterson radiological score. Bone mineral density of the lumbar spine (LS) and femoral neck (FN) were measured using dual-energy X-ray absortiometry. Bone turnover was evaluated by the measurement of: (1) bone resorption markers [N-terminal cross-linking telopeptide of collagen type I (NTX), C-terminal cross-linking telopeptide of collagen type I (CTX), and tartrate-resistant acid phosphatase isoform-5b (TRACP-5b)], (2) bone formation markers [bone-alkaline phosphatase (bALP) and osteocalcin], and (3) osteoclast stimulators (receptor activator of nuclear factor-κB ligand, osteoprotegerin, and tumor necrosis factor-alpha). Osteopenia or osteoporosis was observed in 86% and 65% of the patients in FN and LS, respectively. Osteoporosis was more common among HIV-positive patients in both FN (65.3% vs 41.6%; = 0.007) and LS (17.86% vs 5.41%, = 0.004). The severity of osteoporosis in FN correlated with the patients' total clinical and radiological score ( = 0.001). Hemophilia patients showed increased osteoclastic activity (significant increase of TRACP-5b, NTX, and CTX), which was not accompanied by a comparable increased bone formation (reduced osteocalcin and borderline increase of bALP). In multivariate analysis, HIV infection ( = 0.05) and total clinical score ( = 0.001) were independent risk factors for osteoporosis development. We conclude that there is a high prevalence of osteoporosis among hemophiliacs, which is related to the severity of arthropathy and is enhanced by HIV infection. We report for the first time a high bone resorption that seems not to be balanced by a comparable bone formation

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“…Low body weight has been cited as a causative factor for low BMD in HIV patients. [105][106][107] Conversely, central obesity, as a result of lipodystrophy and associated lipid abnormalities, could play a role in the development of low BMD in HIV-positive patients receiving HAART. A study in HIV-positive men with lipodystrophy demonstrated significant associations between postprandial hyperglycemia and low BMD.…”

Section: Discussionmentioning

confidence: 99%

“…[101][102][103][104][105][106][107][108] Protease inhibitors have been suggested as causative agents for a low BMD, 109 although other studies have not been able to support this fi nding. 101,[103][104][105][106][107][108]110 A meta-analysis of osteoporosis in HIVpositive patients examining data from 20 cross-sectional studies showed a 15% increased prevalence of osteoporosis among HIV-positive subjects compared to HIV-negative controls. Compared to HAART-naïve HIV-positive subjects, receptor and peroxisome proliferator-activated receptor type-γ (RXR-PPARγ) heterodimer, potentially promoting reduced differentiation and increased apoptosis of peripheral adipocytes.…”

Section: Lipid and Bone Metabolism In Hiv/haartmentioning

confidence: 99%

Human Immunodeficiency Virus and Highly Active Antiretroviral Therapy–Associated Metabolic Disorders and Risk Factors for Cardiovascular Disease

Anuurad

Semrad

Berglund

2009

Metabolic Syndrome and Related Disorders

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The successful introduction of highly active antiretroviral therapy (HAART), a combination of potent antiretroviral agents, including protease inhibitors, nucleoside reverse transcriptase inhibitors, and nonnucleoside reverse transcriptase inhibitors, has impacted positively on morbidity and mortality among human immunodefi ciency virus (HIV)-positive patients. Over time, HAART has been associated with a number of metabolic and anthropometric abnormalities, including dyslipidemia and insulin resistance as well as subcutaneous fat loss and abdominal obesity, potentially contributing to cardiovascular risk. Recent studies have more fi rmly established that both HIV infection and HAART might increase the risk of clinical cardiovascular events. Furthermore, whereas HIV/HAART is associated with multiple aspects of endocrine dysfunction, there has been less focus on bone disease, although some studies indicate a higher prevalence of osteoporosis among HIV-positive subjects compared to HIV-negative controls. The relationship between bone and fat metabolism under HIV-positive conditions deserves further attention, and available data suggest the possibility of an intriguing connection. In the future, an increasing population of aging HIV-positive patients with a spectrum of antiretroviral therapies and accumulation of endocrine abnormalities and conventional cardiovascular risk factors will present preventive and therapeutic challenges to our health-care system.

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BMD Is Reduced in HIV-Infected Men Irrespective of Treatment

Cited by 136 publications

References 33 publications

Prevalence of Osteoporosis among HIV-1-Infected Men and Women Aged 50 years and Older in Dakar, Senegal: A Cross-Sectional Study

Prevalence of Osteoporosis among HIV-1-Infected Men and Women Aged 50 years and Older in Dakar, Senegal: A Cross-Sectional Study

Increased bone resorption is implicated in the pathogenesis of bone loss in hemophiliacs: correlations with hemophilic arthropathy and HIV infection

Human Immunodeficiency Virus and Highly Active Antiretroviral Therapy–Associated Metabolic Disorders and Risk Factors for Cardiovascular Disease

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