Time of Progression to Osteopenia/Osteoporosis in Chronically HIV-Infected Patients: Screening DXA Scan

Abstract

BackgroundAlgorithms for bone mineral density (BMD) management in HIV-infected patients are lacking. Our objective was to assess how often a dual-energy x-ray absorptiometry (DXA) scan should be performed by assessing time of progression to osteopenia/osteoporosis.MethodsAll DXA scans performed between 2000 and 2009 from HIV-infected patients with at least two DXA were included. Time to an event (osteopenia and osteoporosis) was assessed using the Kaplan–Meier method. Strata (tertiles) were defined using baseline minimum T scores. Differences between strata in time to an event were compared with the log-rank test.ResultsOf 391 patients (1,639 DXAs), 49.6% had osteopenia and 21.7% osteoporosis at their first DXA scan. Of the 112 (28.6%) with normal BMD, 35.7% progressed to osteopenia; median progression time was 6.7 years. These patients were stratified: “low-risk" (baseline minimum T score >−0.2 SD), “middle-risk" (between −0.2 and −0.6 SD), and “high-risk" (from −0.6 to −1 SD); median progression time to osteopenia was 8.7, >7.2, and 1.7 years, respectively (p<0.0001). Of patients with osteopenia, 23.7% progressed to osteoporosis; median progression time was >8.5 years. Progression time was >8.2 years in “low-risk" tertile (T score between −1.1 and −1.6 SD), >8.5 years in “middle-risk" (between −1.6 and −2), and 3.2 years in “high-risk" (from −2 to −2.4) (p<0.0001).ConclusionsOur results may help to define the BMD testing interval. The lowest T score tertiles would suggest recommending a subsequent DXA in 1–2 years; in the highest tertiles, ≥6 years. Early intervention in patients with bone demineralization could reduce fracture–related morbidity/mortality.

Associated Factors and Liver Disease Severity for Decreased Bone Mineral Density in HIV Mono- and HIV/HCV Co-infected Patients

“…The overall 26% prevalence of frank osteoporosis in our HIV-cohort was higher than the percentages reported in a previous meta-analysis and in other European case studies [1,3,24]. In our HIV/HCV co-infected patients osteoporosis prevalence was significantly higher than among HIV mono-infected subjects, in agreement with previous findings [25].…”

Bone Disease in HIV: Recommendations for Screening and Management in the Older Patient

“…For patients who progressed to osteopenia, osteoporosis was often diagnosed approximately 1 year later. Older age was associated with faster progression in each category of BMD [58]. Therefore, the recommended monitoring interval would be as frequent as every 1-2 years after a diagnosis of low BMD (advanced osteopenia), and 6-7 years in those at low risk of rapid progression of bone loss (Table 5); however, if a new fragility fracture or the development of a major osteoporosis risk factor occurs, monitoring should be carried out more frequently (2-3 years) [58,59].…”

“…Older age was associated with faster progression in each category of BMD [58]. Therefore, the recommended monitoring interval would be as frequent as every 1-2 years after a diagnosis of low BMD (advanced osteopenia), and 6-7 years in those at low risk of rapid progression of bone loss (Table 5); however, if a new fragility fracture or the development of a major osteoporosis risk factor occurs, monitoring should be carried out more frequently (2-3 years) [58,59]. There is insufficient evidence to recommend more frequent screening among HIV-infected patients who are receiving ART medications associated with bone loss (tenofovir DF or PIs).…”

Joint Collaboration in Infectious Diseases in China, the University of Tokyo

“…HIV-1 [14][15][16][17] HIV-1 HIV-1 18-20 21 HIV-1 [18][19][20] HIV-1 HIV-1 21 HIV-1 [22][23][24] HIV-…”