Vitamin D Status and the Relationship with Bone Fragility Fractures in HIV-Infected Patients: A Case Control Study

Abstract

HIV-infected patients show high risk of fracture. The aims of our study were to determine the prevalence of vertebral fractures (VFs) and their associations with vitamin D in HIV patients. 100 patients with HIV infection and 100 healthy age- and sex-matched controls were studied. Bone mineral density was measured by quantitative ultrasound at the non-dominant heel. Serum osteocalcin and C-terminal telopeptide of collagen type 1 served as bone turnover markers. Bone ultrasound measurements were significantly lower in patients compared with controls (Stiffness Index (SI): 80.58 ± 19.95% vs. 93.80 ± 7.10%, respectively, p < 0.001). VFs were found in 16 patients and in 2 controls. HIV patients with vertebral fractures showed lower stiffness index (SI) (70.75 ± 10.63 vs. 83.36 ± 16.19, respectively, p = 0.045) and lower vitamin D levels (16.20 ± 5.62 vs. 28.14 ± 11.94, respectively, p < 0.02). The majority of VFs (87.5%) were observed in HIV-infected patients with vitamin D insufficiency, and regression analysis showed that vitamin D insufficiency was significantly associated with vertebral fractures (OR 9.15; 95% CI 0.18–0.52, p < 0.04). VFs and are a frequent occurrence in HIV-infected patients and may be associated with vitamin D insufficiency.

Low bone mineral density in HIV-positive young Italians and migrants

“…The role of nutrition in maintaining bone health associated with a personalized anti-HIV treatment and daily vitamin supplementation to reduce early bone loss as well as a baseline DXA are critical steps for HIV Migrants and Refugees after arrival in the host countries [13,17,20,23,36]. High-risk groups should be first identified, and osteoporosis investigations should be carried out earlier than at 50 years of age [37][38][39].…”

Vitamin D and Human Health

“…Vitamin D deficiency is inseparably connected to demineralization of bones, which results in an increased susceptibility to fractures. Atteritano and coworkers presented a case study showing the relation between low vitamin D levels and susceptibility to bone fragility fractures in HIV-positive patients [5]. De Luca et al showed that the presence of specific alleles of FokI single nucleotide polymorphism (SNP) in the vitamin D receptor (VDR) gene affects cell proliferation and inflammatory response.…”

The Hidden Burden of Fractures in People Living With HIV

“…(28) There are no studies on mortality and quality of life in HIV þ individuals after a fracture. Nonetheless, just as in (6,32,38) Chronic inflammation (55) Previous fractures (38,59) Reconstitution syndrome (55) Low BMI (32,37,60,61) ART use (8,15,20,27) Tobacco use (38,62) Co-infection with hepatitis B (79) Alcohol abuse (63) Co-infection with hepatitis C (33,80,81) Glucocorticoid use (63) Low CD4 (31,32,38,81) Anticonvulsant use (59) AIDS-defining disease (81) Postmenopausal status (6,24,26) Hypogonadism (38,64) Vitamin D deficiency (24,(65)(66)(67) White race (8,27) Diabetes mellitus (59) Frailty (69) Sarcopenia (38) Selective serotonin reuptake inhibitors (70) Comorbidities (72) Falls (59) R...…”