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Alexandra Calmy, Christoph A. Fux, Richard Norris, Nathalie Vallier, Cécile Delhumeau, Katherine Samaras, Karl Hesse, Bernard Hirschel, David A. Cooper, Andrew Carr, Low Bone Mineral Density, Renal Dysfunction, and Fracture Risk in HIV Infection: A Cross-Sectional Study, The Journal of Infectious Diseases, Volume 200, Issue 11, 1 December 2009, Pages 1746–1754, https://doi.org/10.1086/644785
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Abstract
BackgroundReduced bone mineral density (BMD) is common in adults infected with human immunodeficiency virus (HIV). The role of proximal renal tubular dysfunction (PRTD) and alterations in bone metabolism in HIV-related low BMD are incompletely understood
MethodsWe quantified BMD (dual-energy x-ray absorptiometry), blood and urinary markers of bone metabolism and renal function, and risk factors for low BMD (hip or spine T score, −1 or less) in an ambulatory care setting. We determined factors associated with low BMD and calculated 10-year fracture risks using the World Health Organization FRAX equation
ResultsWe studied 153 adults (98% men; median age, 48 years; median body mass index, 24.5; 67 [44%] were receiving tenofovir, 81 [53%] were receiving a boosted protease inhibitor [PI]). Sixty-five participants (42%) had low BMD, and 11 (7%) had PRTD. PI therapy was associated with low BMD in multivariable analysis (odds ratio, 2.69; 95% confidence interval, 1.09–6.63). Tenofovir use was associated with increased osteoblast and osteoclast activity (P⩽.002). The mean estimated 10-year risks were 1.2% for hip fracture and 5.4% for any major osteoporotic fracture
ConclusionsIn this mostly male population, low BMD was significantly associated with PI therapy. Tenofovir recipients showed evidence of increased bone turnover. Measurement of BMD and estimation of fracture risk may be warranted in treated HIV-infected adults
- hiv
- body mass index procedure
- renal function
- bone mineral density
- kidney failure
- fanconi syndrome
- fractures
- hip fractures
- adult
- ambulatory care services
- hip region
- hip joint
- osteoblasts
- osteoclasts
- protease inhibitor
- urinary tract
- world health organization
- spine
- tenofovir
- hiv infections
- x-ray absorptiometry, dual-energy
- anti-retroviral agents
- osteoporotic fractures
- bone turnover rate
- bone metabolism
- osteoporotic fracture risk
- world health organization frax osteoporotic fracture probability assessment tool