Higher Rates of Bone Loss in Postmenopausal HIV-Infected Women: A Longitudinal Study

Yin, Michael T.; Zhang, Chiyuan A.; McMahon, Donald J.; Ferris, David C.; Irani, Dariush; Colón, Ivelisse; Cremers, Serge; Shane, Elizabeth

doi:10.1210/jc.2011-2197

Cited by 87 publications

(78 citation statements)

References 45 publications

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“…37 Studies conducted among HIV-infected women show varying results. 6 We found a significant, albeit modest, correlation between lower baseline BMD and subsequent gain in BMD at the total hip, with baseline total hip BMD accounting for only 3.6% of the variance in the total hip BMD change over time. We may be limited by the fact that our baseline DXA scans do not reflect a true baseline for the participants, as the median time since HIV diagnosis was 4.8 years and all had at least 2 years of suppressive cART exposure at time of first DXA scan.…”

Section: Discussionmentioning

confidence: 62%

“…[4][5][6] In comparison to controls from NHANES matched by age, sex, race, and BMI, our cohort had significantly lower T-scores at the femoral neck with almost twice as many persons with osteopenia and osteoporosis. These findings confirm other data regarding the robust association of HIV infection with low BMD.…”

Section: Discussionmentioning

confidence: 71%

“…Osteopenia and osteoporosis remain highly prevalent among HIV-infected persons, ranging from 40% to 62% and 14% to 42%, respectively. [4][5][6] Studies that assessed the progression of BMD among HIV-infected persons have yielded inconsistent results. Some studies demonstrated accelerated bone loss, while others showed stable or even increased BMD over time.…”

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confidence: 99%

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High Prevalence of Low Bone Mineral Density and Substantial Bone Loss over 4 Years Among HIV-Infected Persons in the Era of Modern Antiretroviral Therapy

Escota

Mondy

Bush

et al. 2016

AIDS Research and Human Retroviruses

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"High prevalence of low bone mineral density and substantial bone loss over 4 years among HIV-infected persons in the era of modern antiretroviral therapy." AIDS Research and Human Retroviruses.32,1. 59-67. (2016 , 89% with HIV RNA <400 copies/ml), 51% and 10% had baseline osteopenia and osteoporosis, respectively. Low BMD at the femoral neck was significantly more prevalent than for the NHANES controls (47% versus 29%, p < 0.001). Lower body mass index, nonwhite race, longer tenofovir exposure, older age, being unemployed or retired, and lower apolipoprotein E were independently associated with baseline osteoporosis. Among 170 participants virologically suppressed on cART and with longitudinal BMD data, 31% experienced substantial bone loss ( ‡5% BMD decline from baseline) over 4 years. Female sex, current smoking, and longer stavudine use were more common among participants who had substantial bone loss, although these variables failed to reach statistical significance. Low BMD was highly prevalent among HIV-infected persons. One-third of participants experienced substantial bone loss despite cART, suggesting the need for monitoring and potential clinical interventions.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 71%

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High Prevalence of Low Bone Mineral Density and Substantial Bone Loss over 4 Years Among HIV-Infected Persons in the Era of Modern Antiretroviral Therapy

Escota

Mondy

Bush

et al. 2016

AIDS Research and Human Retroviruses

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“…The proximal femur is an important anatomical site for fracture, and femur fractures are usually accompanied with high morbidity and mortality (12). As HIV-infected individuals live longer through effective ART, HIV-related bone deterioration is superimposed upon age-related bone deterioration and is expected to result in greater rates of fragility fractures than in the general population in the near future (13,14). In addition to the effect of HIV infection, it has been shown that ART exacerbates bone loss (15,16).…”

Section: Introductionmentioning

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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“…This chronic inflammation may contribute to the development and progression of bone loss, as indicated by the bone turnover markers N-telopeptide, C-telopeptide, and TNF->. 79,82 BMD, measured by dual-energy x-ray absorptiometry, has been found to decrease by 2% to 6% at both the hip and the spine, followed by stabilization within 1 to 2 years of ART initiation. 83,84 Specific antiretrovirals may be more likely to impact BMD than others.…”

Section: Bone Diseasementioning

confidence: 99%

Human immunodeficiency virus and menopause

2013

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Few studies on menopause have been conducted in HIV-infected women compared with HIV-uninfected women. Many questions regarding age of menopause onset, frequency of menopausal symptoms and associated complications such as bone disease and cardiovascular disease, and efficacy of treatment among HIV-infected women remain. The incidence and severity of some of these factors may be increased in the setting of HIV and cART.

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Higher Rates of Bone Loss in Postmenopausal HIV-Infected Women: A Longitudinal Study

Abstract: HIV+ postmenopausal minority women had lower BMD, increased bone turnover, and higher rates of bone loss than HIV- women. These features may place these women at increased risk for fracture as they age.

Cited by 87 publications

References 45 publications

High Prevalence of Low Bone Mineral Density and Substantial Bone Loss over 4 Years Among HIV-Infected Persons in the Era of Modern Antiretroviral Therapy

High Prevalence of Low Bone Mineral Density and Substantial Bone Loss over 4 Years Among HIV-Infected Persons in the Era of Modern Antiretroviral Therapy

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

Human immunodeficiency virus and menopause

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