Do people with HIV infection have a higher risk of fracture compared with those without HIV infection?

Hoy, Jennifer; Young, Benjamin

doi:10.1097/coh.0000000000000249

Cited by 24 publications

(22 citation statements)

References 32 publications

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“…Whether ART increases fracture risk is unclear, with contradictory results reported from multiple studies. The effect of ART is likely small in women under the age of 50 years and men under 60 years . The young age of our study population may have contributed to the low rate of fractures and lack of treatment group difference…”

Section: Discussionmentioning

confidence: 94%

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Immediate Initiation of Antiretroviral Therapy for HIV Infection Accelerates Bone Loss Relative to Deferring Therapy: Findings from the START Bone Mineral Density Substudy, a Randomized Trial

Hoy

Grund

Roediger

et al. 2017

Journal of Bone and Mineral Research

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Both HIV infection and antiretroviral therapy (ART) are associated with lower bone mineral density (BMD) and increased fracture risk. The relative contributions of ART and untreated HIV to BMD loss are unclear, it is important to quantify the effect of ART on bone. We compared the effect of early ART initiation (CD4 >500 cells/μL) with deferred ART on change in BMD in the START Bone Mineral Density substudy, a randomised trial evaluating the effect of immediate ART initiation versus deferring ART (to CD4 <350 cells/μL). BMD was measured annually at the lumbar spine and hip by dual-energy X-ray absorptiometry (DXA). Percent change in BMD by treatment assignment (intent-to-treat analysis) was estimated using longitudinal mixed models and linear regression. Baseline and follow-up DXA scans were available for 399 (195 immediate, 204 deferred) participants (median age 32 years, 80% non-white, 26% women, median CD4 count 642 cells/μL). ART (most commonly including tenofovir and efavirenz) was used for 95% and 18% of follow-up in the immediate and deferred ART groups, respectively. Through 2.2 years mean follow-up, immediate ART resulted in greater BMD declines than deferred ART at the hip (−2.5% vs. −1.0%; difference −1.5%, 95% CI −2.2 to −0.8, p<0.001) and spine (−1.9% vs. −0.4%; difference −1.6%, 95% CI −2.2 to −1.0, p<0.001). BMD declines were greatest in the first year of ART. In the immediate ART group, spine BMD stabilized after year 1, while hip BMD declined progressively over 2 years. After year 1, BMD changes were similar in the immediate and deferred groups. No clinical, HIV-related or ART characteristic predicted greater BMD loss in either group. All HIV treatment guidelines now recommend ART initiation at HIV diagnosis, due to the reduced risk of serious clinical outcomes. Better understanding of the longer term consequences of the observed reductions in BMD is needed.

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Section: Discussionmentioning

confidence: 94%

“…The effect of ART is likely small in women under the age of 50 years and men under 60 years. (39) The young age of our study population may have contributed to the low rate of fractures and lack of treatment group difference. (14) There was no independent association between baseline CD4 count and change in BMD in the immediate ART group.…”

Section: Discussionmentioning

confidence: 99%

Immediate Initiation of Antiretroviral Therapy for HIV Infection Accelerates Bone Loss Relative to Deferring Therapy: Findings from the START Bone Mineral Density Substudy, a Randomized Trial

Hoy

Grund

Roediger

et al. 2017

Journal of Bone and Mineral Research

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“…Further parameters included an echo time TE =4.2 ms, readout bandwidth rBW =±62.5 kHz, repetition time TR =10 ms and a flip angle α =60°. A spatial resolution of 234×234×500 µm 3 was achieved in approximately 15 minutes of acquisition time. Automatic coil correction by nonparametric nonuniform intensity normalization (N3) (24) was applied to all MR scans.…”

Section: Mri and Image Analysismentioning

confidence: 99%

Trabecular bone microstructure is impaired in the proximal femur of human immunodeficiency virus-infected men with normal bone mineral density

Kazakia

Carballido‐Gamio

Lai

et al. 2018

Quant. Imaging Med. Surg.

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Background: There is evidence that human immunodeficiency virus (HIV) infection and antiretroviral therapy (ART) are independent risk factors for osteoporosis and fracture which is not solely explained by changes in bone mineral density. Thus, we hypothesized that the assessment of trabecular microstructure might play an important role for bone quality in this population and might explain the increased fracture risk. In this study, we have assessed bone microstructure in the proximal femur using high-resolution magnetic resonance imaging (MRI) as well as in the extremities using high resolution peripheral quantitative computed tomography (HR-pQCT) in HIV-infected men and healthy controls and compared these findings to those based on areal bone mineral density (aBMD) derived from dual X-ray absorptiometry (DXA) which is the standard clinical parameter for the diagnosis of osteoporosis.Methods: Eight HIV-infected men and 11 healthy age-matched controls were recruited and informed consent was obtained before each scan. High-resolution MRI of the proximal femur was performed using fully balanced steady state free precession (bSSFP) on a 3T system. Three volumes of interest at corresponding anatomic locations across all subjects were defined based on registrations of a common template. Four MR-based trabecular microstructural parameters were analyzed at each region: fuzzy bone volume fraction (f-BVF), trabecular number (Tb.N), thickness (Tb.Th), and spacing (Tb.Sp). In addition, the distal radius and distal tibia were imaged with HR-pQCT. Four HR-pQCT-based microstructural parameters were analyzed: trabecular bone volume fraction (BV/TV), Tb.N, Tb.Th, and Tb.Sp. Total hip and spine aBMD were determined from DXA.Results: Microstructural bone parameters derived from MRI at the proximal femur and from HR-pQCT at the distal tibia showed significantly lower bone quality in HIV-infected patients compared to healthy controls. In contrast, DXA aBMD data showed no significant differences between HIV-infected patients and healthy controls. Conclusions:Our results suggest that high-resolution imaging is a powerful tool to assess trabecular bone microstructure and can be used to assess bone health in HIV-infected men who show no differences to healthy males by DXA aBMD. Advances in MRI technology have made microstructural imaging at the proximal femur possible. Further studies in larger patient cohorts are clearly warranted.Keywords: Human immunodeficiency virus (HIV); trabecular bone microstructure; high-resolution magnetic resonance imaging (MRI); high resolution peripheral quantitative computed tomography (HR-pQCT); dual X-ray absorptiometry (DXA); areal bone mineral density (aBMD)

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“…[2][3][4][5] HIV-related osteoporosis and osteomalacia occur relatively frequently and put patients at risk for fractures at a rather young age. 6,7 Recent estimations of the prevalence of osteopenia and osteoporosis in HIV + individuals range from 48% to 52% and from 10% to 23%, respectively. [8][9][10] Prospective and retrospective studies have demonstrated decreases in bone mineral density (BMD) of 2%-6% in the first 2 years after the start of cART, depending on the type of cART.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Impact of Calcium and Vitamin D Supplementation on Bone Density in HIV⁺ Patients with Documented Deficiencies

Faber

Bech

Bentum

et al. 2020

AIDS Research and Human Retroviruses

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To assess the efficacy of long-term calcium and vitamin D treatment on bone mineral density (BMD) in HIV + patients on combined antiretroviral therapy (cART). A retrospective, single-center cohort study. Between March 2010 and July 2012, 268 HIV + patients were screened for vitamin D and calcium deficiency. Those with proven vitamin D or calcium deficiency received supplementation according to a predefined protocol, and were offered further evaluation of BMD by dual-energy X-ray absorptiometry (DEXA). Calcium and vitamin D status and BMD were assessed at baseline (T 0) and approximately one (T 1) and 4-6 years (T 2) later. Percentual change in BMD of the lumbar spine and hip was compared with reported rates of change in HIV + patients on cART without standard calcium and vitamin D treatment. The prevalence of vitamin D deficiency and calcium deficiency was 46% and 43%, respectively. Thirteen percent of patients had secondary hyperparathyroidism at baseline. DEXA performed in patients with a deficiency revealed osteopenia in 40% and osteoporosis in 8% of patients. The expected long-term change in lumbar spine and hip BMDs at T 2 was-0.7%,-1.5%, and-1.5%, respectively. The measured changes were +2.3%,-0.6%, and-0.6%, respectively. The difference between measured and expected rate of change was significant for the lumbar spine (3.0%, p < .05), but not for the hip. Long-term vitamin D and calcium supplementation improves lumbar spine BMD of HIV + patients with osteopenia or osteoporosis and with proven calcium and/or vitamin D deficiencies. Screening and treatment are recommended to become part of regular care.

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Do people with HIV infection have a higher risk of fracture compared with those without HIV infection?

Abstract: This review examines data from recent cohort studies and clinical trials to inform a better understanding of the complex relationship between the effects of HIV infection, ART and demographics on fractures in PLWH.

Cited by 24 publications

References 32 publications

Immediate Initiation of Antiretroviral Therapy for HIV Infection Accelerates Bone Loss Relative to Deferring Therapy: Findings from the START Bone Mineral Density Substudy, a Randomized Trial

Immediate Initiation of Antiretroviral Therapy for HIV Infection Accelerates Bone Loss Relative to Deferring Therapy: Findings from the START Bone Mineral Density Substudy, a Randomized Trial

Trabecular bone microstructure is impaired in the proximal femur of human immunodeficiency virus-infected men with normal bone mineral density

Long-Term Impact of Calcium and Vitamin D Supplementation on Bone Density in HIV⁺ Patients with Documented Deficiencies

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Do people with HIV infection have a higher risk of fracture compared with those without HIV infection?

Abstract: This review examines data from recent cohort studies and clinical trials to inform a better understanding of the complex relationship between the effects of HIV infection, ART and demographics on fractures in PLWH.

Cited by 24 publications

References 32 publications

Immediate Initiation of Antiretroviral Therapy for HIV Infection Accelerates Bone Loss Relative to Deferring Therapy: Findings from the START Bone Mineral Density Substudy, a Randomized Trial

Immediate Initiation of Antiretroviral Therapy for HIV Infection Accelerates Bone Loss Relative to Deferring Therapy: Findings from the START Bone Mineral Density Substudy, a Randomized Trial

Trabecular bone microstructure is impaired in the proximal femur of human immunodeficiency virus-infected men with normal bone mineral density

Long-Term Impact of Calcium and Vitamin D Supplementation on Bone Density in HIV+ Patients with Documented Deficiencies

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Product

Resources

About

Long-Term Impact of Calcium and Vitamin D Supplementation on Bone Density in HIV⁺ Patients with Documented Deficiencies