Peripheral DEXA scans to identify rates of reduced bone mineral density
Simon Collins, HIV i-Base
Short and colleagues presented results from using a portable DEXA scanner to identify high rates of reduced bone mineral density and relationship to ARV use in 168 HIV-positive men (median age 45) treated in Brighton.
Both osteopenia and osteoporosis have been reported at alarming rates compared to age- and gender-matched HIV-negative populations, routine bone density assessments, however, are not routinely yet included in patient management. With time, cost and scanner access reported as limiting factors to change this, researchers at Brighton used a donated portable DEXA scanner (cost new ~ £15-20K) and peripheral scans (taking two minutes) as part of a routine outpatient clinic.
Patients were recruited consecutively from May to August 2008 and underwent a forearm portable DEXA and standard DEXA imaging (lumbar spine and femoral neck) within 12 weeks.
Osteopenia at any site by DEXA was found in 100/168 (60%) overall (70% in ARV-naive, 53% in those with <3 years treatment and 58% in the group with > 3 years ARV use. Osteoporosis at any site was found in 22/168 (13%) overall; and at 5%, 11%, 17% by ARV use in the same groups respectively.
ARV exposure/weeks (p=0.03), HIV infection >13 years [OR 2.81 (1.65.1) P = 0.00] and fracture post infection [OR 3.23 (1.66.6) P = 0.02] were independently associated with osteoporosis at any site and no alcohol use was protective [OR 0.35]. Peripheral DXA had a 95% sensitivity and 35% specifificity to identify osteoporosis at any site, with a negative predictive value of 98%.
Short CS et al. Evaluation of peripheral dual energy X-ray absorptiometry to detect osteoporosis in an HIV-seropositive male population. 15th Annual Conference of the British HIV Association (BHIVA), 1-3 April 2009, Liverpool. Oral abstract O2.