Low bone mineral density, renal dysfunction, and fracture risk in HIV infection: a cross-sectional study.
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.
Calmy
Alexandra
A
HIV, Immunology and Infectious Diseases Unit, University of New South Wales, Sydney, Australia. acalmy@gmail.com
Fux
Christoph A
CA
Norris
Richard
R
Vallier
Nathalie
N
Delhumeau
Cécile
C
Samaras
Katherine
K
Hesse
Karl
K
Hirschel
Bernard
B
Cooper
David A
DA
Carr
Andrew
A
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
D044966:Anti-Retroviral Agents