title: Low bone mineral density, renal dysfunction, and fracture risk in HIV infection: a cross-sectional study.
abstract: BACKGROUND
  Reduced 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  We 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< or = .002). The mean estimated 10-year risks were 1.2% for hip fracture and 5.4% for any major osteoporotic fracture.
  
  
  CONCLUSIONS
  In 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.
authors.affiliation: HIV, Immunology and Infectious Diseases Unit, University of New South Wales, Sydney, Australia. acalmy@gmail.com
authors.forename: Alexandra
authors.initials: A
authors.lastname: Calmy
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Fux
authors.forename: Richard
authors.initials: R
authors.lastname: Norris
authors.forename: Nathalie
authors.initials: N
authors.lastname: Vallier
authors.forename: Cécile
authors.initials: C
authors.lastname: Delhumeau
authors.forename: Katherine
authors.initials: K
authors.lastname: Samaras
authors.forename: Karl
authors.initials: K
authors.lastname: Hesse
authors.forename: Bernard
authors.initials: B
authors.lastname: Hirschel
authors.forename: David A
authors.initials: DA
authors.lastname: Cooper
authors.forename: Andrew
authors.initials: A
authors.lastname: Carr
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D015519:Bone Density; D003430:Cross-Sectional Studies; D005198:Fanconi Syndrome / Q000378:metabolism / Q000473:pathology / Q000821:virology*; D005260:Female; D050723:Fractures, Bone / Q000378:metabolism / Q000821:virology*; D015658:HIV Infections / Q000188:drug therapy / Q000378:metabolism* / Q000473:pathology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D018709:Statistics, Nonparametric
chemical_list: D044966:Anti-Retroviral Agents