Increased abdominal visceral fat is associated with reduced bone density in HIV-infected men with lipodystrophy

Huang, Jeannie S.; Rietschel, Petra; Hadigan, Colleen; Rosenthal, Daniel I.; Grinspoon, Steven

doi:10.1097/00002030-200105250-00005

Cited by 113 publications

(76 citation statements)

References 19 publications

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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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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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“…Several studies have attempted to identify risk factors related to these bone disorders [15]. Hyperlipidaemia, lipodystrophy, diabetes and vasculitis have been described as conditions associated with, or related to, bone disorders [16][17][18] and some risk factors have been suggested, such as alcohol abuse, smoking, hyperlactataemia and corticosteroid use [16,[19][20][21][22][23]. It has also been suggested that bone loss could be the consequence of HIV infection itself [7,11,24,25].…”

Section: Introductionmentioning

confidence: 99%

Symptomatic bone disorders in HIV‐infected patients: incidence in the Aquitaine cohort (1999–2002)

et al. 2004

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Background Since the inception of highly active antiretroviral therapy (HAART), mortality among HIV‐infected patients has decreased, but this has been accompanied by the appearance of several complications. Objectives To estimate the incidence of symptomatic bone disorders in HIV‐infected patients of the Aquitaine cohort (from south‐west France) for the period 1999–2002, and to describe cases. Methods We retrospectively studied the records of 2700 patients of the Aquitaine cohort, which was derived from a hospital‐based surveillance system of HIV infection in France. All cases of symptomatic bone disorders diagnosed from 1 January 1999 to 30 June 2002 were reviewed. Results Fourteen cases of bone disorders were diagnosed, eight cases of aseptic osteonecrosis and six cases of severe osteoporosis, representing incidences of 0.3/1000 patient‐years [95% confidence interval (CI): 0.14–0.62] and 0.22/1000 patient‐years (95% CI: 0.09–0.52), respectively. All patients with aseptic osteonecrosis were male, while all but one with osteoporosis were female. The ages of patients ranged from 36 to 54 years for osteonecrosis and from 39 to 50 for severe osteoporosis. At the time of clinical diagnosis, all patients were treated with nucleoside reverse transcriptase inhibitors (duration of treatment ranging from 19 to 123 months for osteonecrosis and from 46 to 132 months for severe osteoporosis). Ten patients were treated with nonnucleoside reverse transcriptase inhibitors [duration of treatment ranging from 6 to 31 months for osteonecrosis (n=6) and from 4 to 29 months for severe osteoporosis (n=4)]. Thirteen patients were treated with protease inhibitors [duration of treatment ranging from 12 to 62 months for osteonecrosis (n=8) and from 3 to 44 months for severe osteoporosis (n=5)]. All osteonecrosis and five osteoporosis patients had at least one known risk factor or comorbidity associated with the bone disorder occurrence. Conclusions In our study, the aetiology of clinical bone disorders seemed to be multifactorial, as almost all the patients had at least one possible risk factor in addition to HAART exposure.

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“…110 Furthermore, a higher degree of visceral obesity was strongly associated with lower trabecular bone density at the lumbar spine, as detected by quantitative computed tomography. 115 This raises the issue of whether a low BMD could result from HIV infection, metabolic complications during antiretroviral therapy, or a combination thereof.…”

Section: Hiv/haart and Cvdmentioning

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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Increased abdominal visceral fat is associated with reduced bone density in HIV-infected men with lipodystrophy

Cited by 113 publications

References 19 publications

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

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

Symptomatic bone disorders in HIV‐infected patients: incidence in the Aquitaine cohort (1999–2002)

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

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