title: Decreased bone mineral density and increased fracture risk in aging men with or at risk for HIV infection.
abstract: BACKGROUND
  Osteopenia has been described in HIV-infected persons, but most studies have not focused on aging men, have not included an HIV-negative comparison group with similar risks to those of the HIV-infected men, or lacked data on fracture rates.
  
  
  METHODS
  We analyzed bone mineral density (BMD) and incident fractures in 559 men who were >or= 49 years old with or at-risk for HIV, including 328 with and 231 without HIV infection.
  
  
  RESULTS
  Median age was 55 years, 56% were black and 89% had used illicit drugs. In unadjusted analysis, BMD was lower in HIV-infected compared with HIV-uninfected men at the femoral neck (0.97 +/- 0.14 versus 1.00 +/- 0.15 g/cm; P < 0.05) and lumbar spine (1.17 +/- 0.20 versus 1.20 +/- 0.21 g/cm; P = 0.06); both differences were significant (P < 0.05) after adjusting for age, weight, race, testosterone level, and prednisone and illicit drug use. Non-black race and body weight were independently associated with BMD at both measurement sites and methadone therapy was independently associated with spine BMD. Among HIV-infected men, 87% had taken antiretrovirals and 74% had taken protease inhibitors, but their use was not associated with BMD. Among men who had at least one subsequent study visit (94%), incident fracture rates per 100 person-years differed among men with normal BMD, osteopenia and osteoporosis (1.4 versus 3.6 versus 6.5; P < 0.01). A 38% increase in fracture rate among HIV-infected men was not statistically significant.
  
  
  CONCLUSIONS
  HIV infection is independently associated with modestly reduced BMD in aging men, and decreased BMD is associated with increased fracture risk.
authors.affiliation: Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, New York 10467, USA. jarnsten@montefiore.org
authors.forename: Julia H
authors.initials: JH
authors.lastname: Arnsten
authors.forename: Ruth
authors.initials: R
authors.lastname: Freeman
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Howard
authors.forename: Michelle
authors.initials: M
authors.lastname: Floris-Moore
authors.forename: Yungtai
authors.initials: Y
authors.lastname: Lo
authors.forename: Robert S
authors.initials: RS
authors.lastname: Klein
mesh_terms: D000368:Aged; D000375:Aging / Q000502:physiology; D023241:Antiretroviral Therapy, Highly Active; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000209:etiology* / Q000503:physiopathology; D004812:Epidemiologic Methods; D005272:Femur Neck / Q000503:physiopathology; D050723:Fractures, Bone / Q000209:etiology* / Q000503:physiopathology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D008019:Life Style; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000209:etiology / Q000503:physiopathology