Prevalence of and risk factors for low bone mineral density in Spanish treated HIV-infected patients

Abstract

ObjectivesSeveral studies have involved antiretroviral therapy in the pathogenesis of low bone mineral density (BMD), while others have not confirmed this association. In this study we analyze the impact of HIV status, traditional risk factors and antiretroviral therapy in BMD in an HIV-infected population living in Madrid.Material and methodsWe performed a cross-sectional analysis of 107 individuals infected with HIV and exposed to antiretroviral treatment to estimate the prevalence of decreased BMD. Bone mineral density of lumbar spine and femoral neck was measured by dual-energy X-ray absorptiometry. In a multivariate analysis variables related with HIV status, antiretroviral drugs and traditional risk factors were included.ResultsLow BMD was diagnosed in 63 participants (58.9%), including osteoporosis in 11 (10%). At least one cause of osteoporosis was identified in 43 patients (40%), with a deficiency of vitamin D in 86 (89%) and secondary hyperparathyroidism in 30 (28%). In multivariate analysis, increasing age, a treatment based on boosted PI and tenofovir DF, and previous exposure to tenofovir were identified as independent risk factors for a decreased BMD in both lumbar spine and femoral neck.ConclusionsWe have confirmed a high prevalence of reduced BMD, which is favoured by ritonavir-boosted PI and TDF. Bone safety should continue to be evaluated in clinical trials and cohort studies in order to demonstrate that the new drugs offer additional advantages regarding the impact on BMD.

Negative correlation between bone mineral density and subclinical fractures in patients with human immunodeficiency virus

“…15 Second, antiretroviral drugs can also cause bone loss. 16 Patients with HIV are more likely to sustain a subclinical fracture than those without HIV because the body's bone mass is affected by the duration of their AIDS illness, and even low-energy trauma or a fall from a low height is sufficient to initiate a fracture. 17 BMD is an important marker of bone quality, reflects the degree of osteoporosis, and is an important basis for predicting the risk of fracture.…”

“…Numerous studies have shown that antiretroviral therapy is associated with bone loss and decreased BMD and consequent subclinical fractures. 16 Das et al 22 proposed that the risk of hip BMD loss may be increased in women aged >40 years taking antiretroviral regimens containing teicoplanin. Recent observational studies have shown a rapid decline in BMD in people living with HIV during the first 2 years of antiretroviral therapy.…”

Osteopenia/Osteoporosis and Vitamine D Levels in Our Group of Male HIV Positive Patients

“…Vitamin D eksikliği %89'dur. İleri yaş, güçlendirilmiş PI ve tenofovir maruziyeti düşük KMY için bağımsız risk faktörü olarak saptanmıştır [12] . %56.5 ve %10.7, kemik mineral dansitesinde azalma ise Brezilya'dan %14.6 olarak bildirilmiştir [13][14][15] .…”

“…Dünya genelinde HIV pozitif bireylerde D vitamini düzeylerinin bildirildiği çalışmalardan bazıları Tablo 3'te sunulmuştur. D vitamini eksikliği oranları bu çalışmalarda %1.6 ile %89 arasında değişmektedir [12,23,25,29,30] . Brezilya'da ekvatora yakın Maceio kentinden bildirilen bu çok düşük oran çalışma grubundaki bireylerin güneş koruyucu kullanmamaları ve güneş ışınlarına maruziyet sürelerinin uzun olmasıyla açıklanmıştır.…”

General Practitioners as partners for a shared management of chronic HIV infection: An insight into the perspectives of Italian People Living with HIV

“…As a consequence, Infectious Diseases (ID) Specialists today are called to embrace challenges that exceed their usual field of expertise, as limiting chronic cART toxicities [ 4 , 5 ], managing poly pharmaceutical therapies and drug-drug interactions (DDIs) [ 6 ], facing ageing-related health issues [ 7 , 8 ] and, ultimately, providing correct scientific information to patients who often surf the Internet in search of health information and get easily caught in fake news and misleading information regarding their chronic condition [ 9 ].…”