High rates of bone loss and progression with HIV in longitudinal study

Mark Mascolini for

Bone mineral density measurements in a 391-person Barcelona study showed progression to osteopenia or osteoporosis in more than one quarter of these HIV-positive people over a median follow-up of 2.5 years. [1]

Longer time taking a protease inhibitor (PI) or tenofovir raised the risk of worsening bone loss. This retrospective analysis focused on 391 HIV clinic patients who had at least two DEXA bone scans between 2000 and 2009. Each person had a median of 3 scans (interquartile range [IQR] 2 to 5), and the median time between scans was 2.5 years (IQR 1.2 to 5.3). Time between scans stretched beyond 5 years in 105 people (27%). Median age of the study group stood at 42.7 years (IQR 38 to 48), and median time on antiretroviral therapy was 8 years (IQR 4.4 to 12). Three quarters of these people were men.

The first DEXA scans in study participants showed osteopenia in 49% and osteoporosis in 22%. Bone loss prevalence is probably higher in this study group than in a general HIV population, since everyone in the study had two or more scans and physicians are more likely to order scans when they suspect a high
risk of bone loss.

From one DEXA scan to the next, 12.5% of study participants progressed from normal bone mineral density to osteopenia and 15.6% progressed from osteopenia to osteoporosis. Among the 105 people with more than 5 years between DEXA scans, 18% progressed from normal bone density to osteopenia and 29% progressed
from osteopenia to osteoporosis.

Multivariate analysis identified three traditional risk factors as independent predictors of progression to osteopenia or osteoporosis. Each year of age raised the risk 7% (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.05 to 1.08, p<0.001), while male gender more than doubled the risk (OR 2.23, 95% CI 1.77 to 2.8, P < 0.0001). Low body mass index also made progression more likely.

Two antiretroviral-related factors raised the risk of progression. Each year of PI therapy raised the risk 18% (OR 1.18, 95% CI 1.12 to 1.24, p<0.001), and each year of tenofovir upped the risk 8% (OR 1.08, 95% CI 1.03 to 1.14, p<0.0019). However, taking a PI when the DEXA was performed lowered the risk of progression (OR 0.61, 95% CI 0.49 to 0.74, p<0.0001).

Ref: Bonjoch A, Figueras M, Puig J, et al. Bone mineral density in a large cohort of HIV infected patients. 50th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), 12–15 September 2010, Boston. Abstract H-226.

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