Longitudinal Assessment of Bone Mineral Density in Women Living With and Without HIV Across Reproductive Phases

Abstract

Background: Women living with HIV commonly experience low areal bone mineral density (BMD), but whether this is impacted by low ovarian hormonal states (prolonged amenorrhea or menopause) is unknown. We compared rates of BMD loss between women living with HIV and HIV-negative control women and investigated its association with low ovarian hormonal states. Setting: Women living with HIV were enrolled from Vancouver Canada and controls from nine Canadian sites. Methods: This longitudinal analysis included age-matched women living with HIV in the Children and Women: AntiRetrovirals and Markers of Aging cohort and controls in the population-based Canadian Multicentre Osteoporosis Study. Rate of change/year in BMD at the total hip (TH) and lumbar spine (L1-4) between 3-5 years was compared between groups, adjusting for sociodemographic and clinical variables. Results: Ninety-two women living with HIV (median [IQR] age: 49.5 [41.6 to 54.1] years and BMI: 24.1 [20.7 to 30.8] kg/m2) and 278 controls (age: 49.0 [43.0 to 55.0] years and BMI: 25.8 [22.9 to 30.6] kg/m2) were included. TH BMD loss was associated with HIV (β: -0.003 (95% CI: -0.006 to -0.0001) g/cm2/year), menopause (β: -0.007 (-0.01 to -0.005) g/cm2/year), and smoking (β: -0.003 (-0.006 to -0.0002) g/cm2/year); BMD gain was linked with higher BMI (β: 0.0002 (0.0007 to 0.0004) g/cm2/year). Menopause was associated with losing L1-4 BMD (β: -0.01 (-0.01 to -0.006) g/cm2/year). Amenorrhea was not associated with BMD loss. Conclusions: HIV and menopause negatively influenced TH BMD. These data suggest women living with HIV require hip BMD monitoring as they age.