Osteoporosis, Rather Than Sarcopenia, Is the Predominant Musculoskeletal Disease in a Rural South African Community Where Human Immunodeficiency Virus Prevalence Is High: A Cross-Sectional Study

Abstract

The rollout of antiretroviral therapy globally has increased life expectancy across Southern Africa, where 20.6 million people now live with human immunodeficiency virus (HIV). We aimed to determine the prevalence of age‐related osteoporosis and sarcopenia, and investigate the association between HIV, bone mineral density (BMD), muscle strength and lean mass, and gait speed. A cross‐sectional community‐based study of individuals aged 20–80 years in rural South Africa collected demographic and clinical data, including HIV status, grip strength, gait speed, body composition, and BMD. Sarcopenia was defined by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) guidelines, and osteoporosis as BMD T‐score ≤ −2.5 (if age ≥50 years). The mean ± standard deviation (SD) age of 805 black South African participants was 44.6 ± 14.8 years, 547 (68.2%) were female; 34 (13.2%) were men, and 129 (23.6%) women had HIV, with 88% overall taking anti‐retroviral therapy. A femoral neck T‐score ≤ −2.5, seen in four of 95 (4.2%) men and 39 of 201 (19.4%) women age ≥50 years, was more common in women with than without HIV (13/35 [37.1%] versus 26/166 [15.7%]; p = 0.003). Although no participant had confirmed sarcopenia, probable sarcopenia affected more men than women (30/258 [11.6%] versus 24/547 [4.4%]; p = .001]. Although appendicular lean mass (ALM)/height2 index was lower in both men and women with HIV, there were no differences in grip strength, gait speed, or probable sarcopenia by HIV status. Older age, female sex, lower ALM/height2 index, slower gait speed, and HIV infection were all independently associated with lower femoral neck BMD. In conclusion, osteoporosis rather than sarcopenia is the common musculoskeletal disease of aging in rural South Africa; older women with HIV may experience greater bone losses than women without HIV. Findings raise concerns over future fracture risk in Southern Africa, where HIV clinics should consider routine bone health assessment, particularly in aging women. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Impaired Bone Architecture in Peripubertal Children With HIV, Despite Treatment With Antiretroviral Therapy: A Cross-Sectional Study From Zimbabwe

“…Recent data from rural South Africa identified a 37% prevalence of femoral neck osteoporosis in women aged ≥50 years living with HIV. ( 49 ) Understanding fracture risk in African women living with HIV is an important research priority.…”

Osteoporosis and HIV Infection

“…The prevalence and incidence of osteoporosis in PLWH are increased compared to controls, especially from the fifth decade [ 14 , 18 ]. This has been demonstrated in various populations, including women in rural South Africa [ 19 ]. The magnitude of the difference of bone mineral density (BMD) between PLWH and controls has been estimated in a meta-analysis to lower BMD Z-scores of − 0.36 standard deviations (95% CI − 0.39 to − 0.15) at the spine and − 0.31 standard deviations (− 0.46 to − 0.27) at the hip [ 10 , 11 ].…”

“…The prevalence and incidence of osteoporosis in PLWH are increased compared to controls, especially from the fifth decade [14,18]. This has been demonstrated in various populations, including women in rural South Africa [19].…”

A Descriptive Cross-Sectional Study on the Incidence of Osteoporosis among Adults

“…In an advanced era of technology, osteoporosis is still a challenging issue in many regions due to the risk of fractures [1][2] . Lack of distinct symptoms causes hurdles in early diagnosis; however, this disease is categorized by less bone mass, worsening the bone tissue, and retardation of bone microarchitecture [3][4] . Along with this; osteoporosis is highly associated with weakness of bones and enhanced the risk of fractures even with trivial trauma.…”