Comparison of quantitative ultrasonography and dual X-ray absorptiometry for bone status assessment in South African children living with HIV

Abstract

Children living with HIV (CLHIV) have decreased bone mineral content (BMC) and density (BMD), increasing risk for fracture and future osteoporosis. While DXA is the gold-standard for bone assessments, it lacks availability in resource-constrained settings (RCS). Quantitative ultrasound (QUS) offers an alternative owing to its portability, low cost, ease of handling, and lack of ionizing radiation. While QUS has detected reduced bone quality in CLHIV, the relationship between QUS and DXA in this population remains unexplored. At baseline and 12 months, BMC and BMD of the whole body, lumbar spine, and radius were measured by DXA in a longitudinal cohort of CLHIV in Johannesburg, South Africa. Calcaneal speed of sound (SOS) and broadband ultrasound attenuation (BUA) and radius SOS were obtained by QUS, and calcaneal stiffness index (SI) was calculated. Spearman correlations, with and without HIV stratification, were performed between QUS and DXA measurements at each visit and for absolute difference in measurements between visits. At baseline and 12-months, calcaneal BUA and SI displayed strong positive correlations with DXA, with only modest correlations between radial QUS and DXA at baseline. Longitudinal measures of QUS did not correlate with DXA. At both baseline and 12-months, individuals with DXA whole-body BMD z-score < -1 displayed significantly lower calcaneal BUA and SI. Cross-sectionally, calcaneal QUS correlates strongly with whole body DXA and may represent a viable diagnostic alternative in RCS. Longitudinally, the two methods do not correlate well, possibly reflecting that each method assesses distinct aspects of bone architecture.

Health-Related Physical Fitness Evaluation in HIV-Diagnosed Children and Adolescents: A Scoping Review

“…Regarding the methods/protocols and cut-points applied to investigate the healthrelated physical fitness components in HIV-diagnosed children and adolescents, the use of reference methods to investigate the different health-related physical fitness components was highlighted [53,[59][60][61], as well as alternatives field tests that are more accessible for use in epidemiological studies [53,62,63]. However, only 13 studies that aimed to validate methods for investigating the health-related physical fitness components were identified [32,34,35,[64][65][66][67][68][69][70][71][72][73], of which 12 studies investigated the validation of methods for assessing body composition [32,35,[64][65][66][67][68][69][70][71][72][73]. Furthermore, studies that proposed reference values for evaluating health-related physical fitness were not identified.…”

“…Observing the aim of the studies, the results of the present scoping review reflect a broad descriptive investigation of differences between HIV-diagnosed populations and HIV non diagnosed peers [11,19,21,[23][24][25][26]29,30,38,51,73,, prevalences related to health-related physical fitness components [12,[117][118][119][120][121][122][123][124] and different associations [7,8,10,14,15,18,20,22,27,31,33,36,37,[39][40][41][42][43]45,47, between health-related physical fitness components and variables such as the HIV infection status (viral load, CD4 and CD8 lymphocyte count and immunosuppression status) [8,45,134,150] and use of different ART regimens [19,…”