Trabecular and Cortical Microarchitecture in Postmenopausal HIV-Infected Women

Abstract

Objective To assess the effects of HIV infection and antiretroviral therapy (ART) on trabecular and cortical microarchitecture in postmenopausal minority women. Methods A subgroup of 106 (46 HIV-infected, 60 uninfected) postmenopausal Hispanic and African American women from an established cohort had areal bone mineral density (aBMD) measured by dual-energy x-ray absorptiometry, and trabecular and cortical volumetric BMD (vBMD) and microarchitecture measured by high-resolution peripheral quantitative computed tomography (HRpQCT) at the radius and tibia. Results HIV-infected women were slightly younger (58±1 versus 61±1 yrs, p=0.08), and had lower body mass index (BMI, 28±1 versus 32±1 kg/m2, p<0.01). BMI-adjusted aBMD Z scores were lower in HIV-infected women at the lumbar spine, total hip and ultradistal radius. Serum N-telopeptide and C-telopeptide levels were also higher in HIV-infected women. Trabecular and cortical vBMD were similar at the radius, but cortical area (105.5±2.4 versus 120.6±2.0mm2, p<0.01) and thickness (956±33 versus 1075±28 m, p<0.01) at the tibia were approximately 11–12% lower in HIV-infected women. Differences remained significant after adjusting for age, BMI and race/ethnicity. In contrast, cortical porosity was similar in both groups. Conclusion Although HIV-infected postmenopausal women had lower aBMD at the spine, total hip and ultradistal radius and higher levels of bone resorption markers, the only differences detected by HRpQCT were lower cortical thickness and area at the tibia.

Trabecular bone microstructure is impaired in the proximal femur of human immunodeficiency virus-infected men with normal bone mineral density

“…Biver et al (10) found trabecular bone microstructure alterations with lower Tb.N and higher Tb.Sp at the distal radius, as well as lower DXA aBMD at the total femur and ultra-distal radius, in HIVinfected men (median age =64 years) compared to healthy age-, BMI-, and gender-matched controls. In contrast, Yin et al (11) did not find significant differences in structural HR-pQCT parameters of trabecular bone at the distal radius and distal tibia between HIV-infected women (mean age =58 years) and uninfected controls, but found lower DXA aBMD at the spine, total hip and ultradistal radius in HIV-infected women.…”

“…To the best of our knowledge, only two published studies have investigated bone quality in older HIV-infected individuals (10,11). However, these studies investigated bone quality only at the extremities using HR-pQCT and reported conflicting results.…”

“…Data supporting this theory have been reported for the extremities (10,11), however, no study has determined whether central skeletal sites are affected similarly. The proximal femur is an important anatomical site for fracture, and femur fractures are usually accompanied with high morbidity and mortality (12).…”

Hepatitis C virus coinfection as a risk factor for osteoporosis and fracture

“…HRpQCT allows for 3-dimensional assessment of bone macro- and microarchitecture (e.g., cortical porosity and trabecular connectivity) of the distal radius and tibia. This technology has showed increased cortical porosity in post-menopausal women [66], patients with type 2 diabetes mellitus [67], and with HIV-1 infection [68]. …”

HIV infection and osteoporosis

“…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. 49 Finally, Yin et al 50 have recently reported reduced trabecular bone density in the tibia and radius and lower cortical and trabecular thickness in young American-African or Hispanic men.…”