Reduced bone mineral density in HIV-positive women

In the last oral presentation at the workshop, Steven Grinspoon presented results from an observational study showing significantly reduced bone mineral density in HIV-positive women compared to BMI and age-matched HIV-negative women. [19]

The study from Massachusetts General Hospital compared results from DEXA and hormonal indices of 84 HIV-positive women to 63 HIV-negative controls (mean age 41, BMI 26-27, 50-60% Caucasian). Bone density and T score were significantly reduced in the HIV-positive women at lumbar spine and hip (p=0.03 and p=0.04 respectively) compared to controls.

Osteopenia was demonstrated in 54% versus 30% (p=0.004) and osteoporosis in 10% versus 5% (p=0.27). 1,25-dihydroxyvitamin D was reduced and urinary NTx and osteoprotegrin both increased in the HIV-positive group but serum calcium, phosphorus, estradiol, FSH, PTH, osteocalcin and 25-hydroxyvitamin D levels were similar in both groups.

Among the HIV-positive women, bone density correlated with body mass and total body fat (both p<0.001) and negatively with urinary NTx.

Increased bone resorption, together with altered nutritional status, hormonal function and body composition may be responsible for these changes and, given that women are at increased risk for osteopenia, suggests that integrating bone density monitoring should be an important part of care for HIV-positive women.

This article is part of a longer report from the 5th International Workshop on Adverse Drug Reactions and Lipodystrophy, 8-11 July 2003, Paris. Part five of this report.