Low Bone Mineral Density, Renal Dysfunction, and Fracture Risk in HIV Infection: A Cross‐Sectional Study

Calmy, Alexandra; Fux, Christoph A; Norris, Richard H.; Vallier, N; Delhumeau, Cécile; Samaras, Katherine; Hesse, Karl; Hirschel, Bernard; Cooper, David A.; Carr, Andrew

doi:10.1086/644785

Cited by 131 publications

(85 citation statements)

References 30 publications

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“…Available data on the role for HIV-related factors in bone loss among HIV-1-infected patients are conflicting [6]. Some studies have suggested that the use of protease inhibitor and of TDF was associated with an increased risk of osteopenia and osteoporosis [1,12,17,24,25] while others failed to confirm this association [18,20,26,27]. In the present study, neither protease inhibitors nor TDF was associated to bone loss with statistical significance, although weak trends of association were observed at several sites for TDF.…”

Section: Discussioncontrasting

confidence: 71%

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: Discussioncontrasting

confidence: 71%

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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“…Therefore, the power calculation of this study was computed using literature data on osteopenia in HIV+ve and HIV−ve patients [1,20,21]. Cases and controls were matched 1:2 by age (±3 years) and BMI (±0.5 kg/m 2 ).…”

Section: Statisticsmentioning

confidence: 99%

Long-term HIV infection and antiretroviral therapy are associated with bone microstructure alterations in premenopausal women

et al. 2012

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Summary We evaluated the influence of long-term HIV infection and its treatment on distal tibia and radius microstructure. Premenopausal eumenorrheic HIV-positive women displayed trabecular and cortical microstructure alterations, which could contribute to increased bone fragility in those patients. Introduction Bone fragility is an emerging issue in HIVinfected patients. Dual-energy X-ray absorptiometry (DXA) quantified areal bone mineral density (BMD) predicts fracture risk, but a significant proportion of fracture risk results from microstructural alterations. Methods We studied the influence of long-term HIV infection on bone microstructure as evaluated by high-resolution peripheral quantitative computed tomography (HR-pQCT) in 22 HIV-positive (+ve) premenopausal eumenorrheic women and 44 age-and body mass index (BMI)-matched HIV-negative (−ve) controls. All subjects completed questionnaires regarding calcium/protein intakes and physical activity, and underwent DXA and HR-pQCT examinations for BMD and peripheral skeleton microstructure, respectively. A risk factor analysis of tibia trabecular density using linear mixed models was conducted. Results In HIV+ve women on successful antiretroviral therapy (undetectable HIV-RNA, median CD4 cell count, 626), infection duration was 16.5±3.5 (mean ± SD)years; median BMI was 22 (IQR, 21-26)kg/m 2 . More HIV+ve women were smokers (82 versus 50 %, p00.013). Compared to controls, HIV+ve women had lower lumbar spine (spine T-score −0.70 vs −0.03, p00.014), but similar proximal femur BMD. At distal tibia, HIV+ve women had a 14.1 % lower trabecular density and a 13.2 % reduction in trabecular number compared to HIV−ve women (p00.013 and 0.029, respectively). HR-pQCT differences in distal radius were significant for cortical density (−3.0 %; p00.029). Conclusions Compared with HIV−ve subjects, premenopausal HIV+ve treated women had trabecular and cortical bone alterations. Adjusted analysis revealed that HIV status was the only determinant of between group tibia trabecular density differences. The latter could contribute to increased bone fragility in HIV+ve patients.

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“…HIV-infected adults receiving ART have more osteopaenia than uninfected adults [61], and TDF has been associated with an increased risk of osteopenia compared with stavudine in randomized trials [62]. However, the fraction of risk attributable to cART regimen components, HIV infection and patient characteristics is still unclear [63], and no recommendations have yet been issued regarding bone mineral density screening for TDF use.…”

Section: Overview Of Alternative First-line Optionsmentioning

confidence: 99%

Improving first-line antiretroviral therapy in resource-limited settings

Ford

Calmy

2010

Current Opinion in HIV and AIDS

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Low Bone Mineral Density, Renal Dysfunction, and Fracture Risk in HIV Infection: A Cross‐Sectional Study

Abstract: In this mostly male population, low BMD was significantly associated with PI therapy. Tenofovir recipients showed evidence of increased bone turnover. Measurement of BMD and estimation of fracture risk may be warranted in treated HIV-infected adults.

Cited by 131 publications

References 30 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

Long-term HIV infection and antiretroviral therapy are associated with bone microstructure alterations in premenopausal women

Improving first-line antiretroviral therapy in resource-limited settings

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