Long-term HIV infection and antiretroviral therapy are associated with bone microstructure alterations in premenopausal women

Abstract

Summary We evaluated the influence of long-term HIV infection and its treatment on distal tibia and radius microstructure. Premenopausal eumenorrheic HIV-positive women displayed trabecular and cortical microstructure alterations, which could contribute to increased bone fragility in those patients. Introduction Bone fragility is an emerging issue in HIVinfected patients. Dual-energy X-ray absorptiometry (DXA) quantified areal bone mineral density (BMD) predicts fracture risk, but a significant proportion of fracture risk results from microstructural alterations. Methods We studied the influence of long-term HIV infection on bone microstructure as evaluated by high-resolution peripheral quantitative computed tomography (HR-pQCT) in 22 HIV-positive (+ve) premenopausal eumenorrheic women and 44 age-and body mass index (BMI)-matched HIV-negative (−ve) controls. All subjects completed questionnaires regarding calcium/protein intakes and physical activity, and underwent DXA and HR-pQCT examinations for BMD and peripheral skeleton microstructure, respectively. A risk factor analysis of tibia trabecular density using linear mixed models was conducted. Results In HIV+ve women on successful antiretroviral therapy (undetectable HIV-RNA, median CD4 cell count, 626), infection duration was 16.5±3.5 (mean ± SD)years; median BMI was 22 (IQR, 21-26)kg/m 2 . More HIV+ve women were smokers (82 versus 50 %, p00.013). Compared to controls, HIV+ve women had lower lumbar spine (spine T-score −0.70 vs −0.03, p00.014), but similar proximal femur BMD. At distal tibia, HIV+ve women had a 14.1 % lower trabecular density and a 13.2 % reduction in trabecular number compared to HIV−ve women (p00.013 and 0.029, respectively). HR-pQCT differences in distal radius were significant for cortical density (−3.0 %; p00.029). Conclusions Compared with HIV−ve subjects, premenopausal HIV+ve treated women had trabecular and cortical bone alterations. Adjusted analysis revealed that HIV status was the only determinant of between group tibia trabecular density differences. The latter could contribute to increased bone fragility in HIV+ve patients.

Structural Bone Deficits in HIV/HCV-Coinfected, HCV-Monoinfected, and HIV-Monoinfected Women

“…Coinfected men had compromised bone strength at the narrow neck and shaft of the proximal femur, and the smaller cortical area of the shaft coupled with normal bone width (ie, periosteal circumference) was consistent with endocortical bone deficits, similar to our findings with pQCT. Finally, 2 studies used high-resolution pQCT to evaluate bone microstructure in ART-treated HIV-infected premenopausal women [49] and young men [50], and both identified trabecular and cortical bone deficits compared with HIV-uninfected controls.…”

The Hidden Burden of Fractures in People Living With HIV

“…Calmi and colleagues found a decrease in the trabecular number and trabecular density in the tibial bone of HIV + women using ART when compared with HIV − women . They also found a decrease in the cortical density of the radius of HIV + women when compared with controls . In postmenopausal African American and Hispanic women, the cortical area and thickness of the tibia were approximately 12% lower in HIV + than in HIV − individuals .…”

“…Changes in trabecular and cortical bone structure have been described in premenopausal and postmenopausal women, as well as in young and middle‐aged men . Calmi and colleagues found a decrease in the trabecular number and trabecular density in the tibial bone of HIV + women using ART when compared with HIV − women . They also found a decrease in the cortical density of the radius of HIV + women when compared with controls .…”

HIV infection and osteoporosis

“…In 22 HIV-infected premenopausal women, Calmy et al 48 reported significantly lower tibial trabecular bone density and trabecular number, and a significantly lower cortical density in the radius when compared with non-infected controls. In 46 HIV-positive postmenopausal women, tibial cortical thickness and cortical area were significantly lower than control values, but no differences were seen in the radius.…”