Prevalence of Osteoporosis among HIV-1-Infected Men and Women Aged 50 years and Older in Dakar, Senegal: A Cross-Sectional Study

Abstract

IntroductionA higher prevalence of low bone mineral density (BMD) and osteoporosis has been described in HIV-1-infected patients compared with HIV-uninfected subjects [1][2][3]. Recent data also suggest that HIV-1-infected people experience higher risks of osteoporosis-related fractures [4,5]. Several factors are involved in the pathogenesis of osteoporosis including traditional factors such as age, gender, low weight, current smoking, reduced physical activity, malnutrition and sex hormone deficiency; but also HIV infection specific risk factors and HIV treatment [6,7].Most studies have been conducted in North America (among both Caucasian and Black American people) and in Europe and bone status is poorly documented in patients living in Sub-Saharan Africa. We have previously reported that quantitative ultrasound (QUS) bone mineral density was lower in HIV-positive patients compared with negative controls from a cross-sectional study conducted in Dakar, Senegal [8]. However, in accordance with International Society Clinical Densitometry (ISCD) 2013 official positions, prevalence of osteoporosis could not be derived from QUS measures [9]. To date, information on osteoporosis among African populations is lacking. Several studies among HIV-positive and negative people reported higher bone mineral density, especially at femoral neck and total hip, as well as lower risk of fracture in African-American compared to Caucasians [10][11][12][13]. If these characteristics are also applied to Africans, it could be expected that HIV-1-infected patients living in sub-Saharan Africa would experience less osteoporosis. Conversely, patients living in resource-limited settings may be more affected by nutritional deficiencies and wasting which are known to be associated with low BMD [6,14].The aim of this cross-sectional study was to estimate the prevalence of osteoporosis based on dual energy X-absorptiometry (DXA) measurements of bone mineral density in Senegalese HIV-1-infected patients living in Dakar and to identify factors associated with osteoporosis in this population. The study focused on men and women aged over 50, for whom diagnosis of osteoporosis from DXA is fully applicable. Methods Study setting and patient populationFrom October, 2012 to February, 2013, a cross-sectional study was conducted at Fann University Hospital in Dakar. All HIV-1-infected AbstractBackground: Published studies reported a high prevalence of osteoporosis among HIV-1-infected subjects, but none of them were conducted in Sub-Saharan Africa. The objective was to estimate prevalence of osteoporosis based on dual energy X-absorptiometry bone mineral density in Senegalese patients above 50 years of age and to identify associated factors.

TDF and quantitative ultrasound bone quality in African patients on second line ART, ANRS 12169 2LADY sub-study

“…Yet, to date QUS technology is not recommended by the World Health Organization nor by the International Society for Clinical Densitometry (ISCD) as a means to diagnose osteoporosis because there is no consensus on the type of QUS device that should be used, measured variables, or cutoffs for osteoporosis diagnosis. As a consequence, very limited data is available regarding the prevalence of osteoporosis in sub-African settings [ 30 , 31 ]. Calcaneal QUS can, however, be used as a screening tool to identify people at high risk, based on device-specific cutoffs that are pre-validated in a specific population [ 32 ].…”