Bone mineral density is not reduced in HIV‐infected Caucasian men treated with highly active antiretroviral therapy

Bolland, Mark J; Grey, Andrew; Horne, Anne; Briggs, Simon; Thomas, Mark G.; Rb, Ellis-Pegler; Woodhouse, Andrew; Gamble, Greg; Reid, Ian R.

doi:10.1111/j.1365-2265.2006.02572.x

Cited by 46 publications

(37 citation statements)

References 42 publications

(165 reference statements)

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“…Meanwhile, in a previous study we compared QUS BMD between HIV-1-infected patients and controls in Senegal and showed that HIV patients had a lower BMD, which was partly explained by lower BMI [8]. This report was consistent with several studies suggested that differences in BMI and body composition between HIV-1-infected and uninfected subjects may largely account for differences in BMD [21,22]. In contrast, a recent study conducted among 247 black South African women reported no difference in BMD DXA measurements by HIV infection status despite HIV positive women being lighter and with lower BMI [23].…”

Section: Discussionsupporting

confidence: 77%

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

Cournil¹

2015

J AIDS Clin Res

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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.

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Section: Discussionsupporting

confidence: 77%

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

Cournil¹

2015

J AIDS Clin Res

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“…27 None of the other recent datasets of HIV infected patients reporting a high prevalence of OP and progression to lower BMD was directly comparable to ours, as they did not share the same inclusion criteria and/or study design, none of them providing universal screening of BMD as the only criterion. 16,21,[24][25][26]28,29 Bonjoch et al, 26 for instance, found 47.5% of osteopenic and 23% of frankly osteoporotic patients among 671 selected HIV patients at increased risk of BMD loss, investigated by retrospective retrieval of DXA scan data. In a longitudinal assessment of BMD in HIV-infected women compared with uninfected controls, Dolan et al 16 found lower levels of BMD among HIV-infected patients and higher levels of osteocalcin and urine N-telopeptide of type 1 collagen, an observation confirmed at follow-up.…”

Section: Discussionmentioning

confidence: 98%

Prevalence and Predictors of Low Bone Mineral Density and Fragility Fractures Among HIV-Infected Patients at One Italian Center After Universal DXA Screening: Sensitivity and Specificity of Current Guidelines on Bone Mineral Density Management

Mazzotta

Ursini²,

Agostinone³

et al. 2015

AIDS Patient Care and STDs

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Low bone mineral density (BMD) is frequent in HIV infection regardless of the use of antiretroviral therapy (ART). Uncertainties remain, however, as to when in HIV infection BMD screening should be performed. We designed a prospective study to estimate the efficacy of universal BMD screening by dual-energy X-ray absorptiometry (DXA). Since April 2009 through March 2011, HIV patients attending our Center were offered femoral/lumbar DXA to screen BMD. Low BMD for chronological age, that is significant osteopenia, was defined as a Z-score ≤ -2.0 at femur and lumbar spine. Nontraumatic bone fractures (NTBFs) were evaluated. The final sample included 163 patients. A Z-score ≤ -2.0 at any site was observed in 19.6% of cases: among these, 18.8% had no indication to DXA using current Italian HIV guidelines for BMD screening. A lower femoral Z-score was independently associated with lower BMI, AIDS diagnosis, HCV co-infection, antiretroviral treatment, and NTBFs; a lower lumbar Z-score with age, BMI, Nadir CD4 T-cell counts, and NTBFs. Prevalence of NTBFs was 27.0%, predictors being male gender, HCV co-infection, and lower femoral Z-scores. Our results suggest that measuring BMD by DXA in all HIV patients regardless of any further specification may help retrieving one-fifth of patients with early BMD disorders not identified using current criteria for selective screening of BMD.

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“…The use of HAART and duration of use has been similar in HIV patients with normal and decreased BMD [4]. The decrease in weight and BMI in HIV patients may be more linked to the decreased BMD [31,36,37] than the use of HAART. Bone mineral density (BMD) and content (BMC) has been shown to remain stable for 2-6 years in adults [32][33][34] or even to increase [35] in adult patients mainly treated with HAART.…”

Section: Drugs Against Hivmentioning

confidence: 93%

“…However in vivo, evidence for a negative effect of HAART has been scarcer, and has so far been based on theoretical considerations [25]. In fact BMD has been shown to be stable and not significantly reduced in patients treated with HAART in many studies [4,[31][32][33][34][35][36][37][38][39]. The use of HAART and duration of use has been similar in HIV patients with normal and decreased BMD [4].…”

Section: Drugs Against Hivmentioning

confidence: 99%

Adverse Effects of Drugs on Bone and Calcium Metabolism/Physiology

Vestergaard

2007

Clinic Rev Bone Miner Metab

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Drugs may affect bone turnover and density in many ways. However, the disease for which the drugs are administered may also contribute to bone loss. Infection with human immunodeficiency virus leads to a loss of bone mineral, while treatment with highly active antiretroviral therapy does not seem to contribute to further bone loss. Type 1 diabetes is associated with a decrease in bone mineral, while type 2 diabetes is associated with an increase. The new class of thiazolidinediones (glitazones) has been associated with an increased loss of bone mineral. In breast cancer treatment, tamoxifen is associated with an increased bone mineral, while the newer class of aromatase inhibitors through a decrease in serum oestradiol are associated with an increased loss of bone mineral. Strong analgesics (opioids) may decrease bone mineral density through inhibition of gonadotrophins while weak analgesics such as the non-steroidal anti-inflammatory drugs may increase bone mineral through an effect on the prostaglandin system. However, possibly through an increased risk of falls, the weak analgesics are associated with an increased risk of fractures. Proton pump inhibitors may lead to a decreased calcium absorption and thus a decreased bone mineral and an increased risk of fractures.

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Bone mineral density is not reduced in HIV‐infected Caucasian men treated with highly active antiretroviral therapy

Abstract: HIV-infected men treated with HAART are lighter than healthy controls. This weight difference is responsible for a small decrement in hip BMD. Overall, BMD is not significantly reduced in HIV-infected Caucasian men treated with HAART.

Cited by 46 publications

References 42 publications

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

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

Prevalence and Predictors of Low Bone Mineral Density and Fragility Fractures Among HIV-Infected Patients at One Italian Center After Universal DXA Screening: Sensitivity and Specificity of Current Guidelines on Bone Mineral Density Management

Adverse Effects of Drugs on Bone and Calcium Metabolism/Physiology

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