title: Prospective study of bone mineral density changes in aging men with or at risk for HIV infection.
abstract: OBJECTIVE
  To investigate rates and predictors of change in bone mineral density (BMD) in a cohort of aging men with or at risk for HIV infection.
  
  
  METHODS
  A prospective cohort study among 230 HIV-infected and 159 HIV-uninfected men aged at least 49 years.
  
  
  METHODS
  Longitudinal analyses of annual change in BMD at the femoral neck, total hip, and lumbar spine.
  
  
  RESULTS
  At baseline, 46% of men had normal BMD, 42% had osteopenia, and 12% had osteoporosis. Of those men with normal BMD, 14% progressed to osteopenia and 86% continued to have normal BMD. Of the men initially with osteopenia, 12% progressed to osteoporosis and 83% continued to have osteopenia. Osteopenia incidence per 100 person-years at risk was 2.6 for HIV-uninfected men and 7.2 for HIV-infected men; osteoporosis incidence was 2.2 per 100 person-years at risk among men with osteopenia, regardless of HIV status. In multivariable analysis of annual change in BMD at the femoral neck, we found a significant interaction between heroin use and AIDS diagnosis, such that the greatest bone loss occurred with both AIDS and heroin use (adjusted predicted mean annual bone loss 0.0196 g/cm). Hepatitis C virus seropositivity was also associated with femoral neck bone loss (P = 0.04). The interaction between AIDS and heroin use also was associated with bone loss at the total hip, as was current methadone use (P < 0.01).
  
  
  CONCLUSIONS
  We found an association of heroin use and AIDS with BMD change, suggesting that heroin users with AIDS may be at particular risk for bone loss.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, New York 11203, USA. anjali.sharma@downstate.edu
authors.forename: Anjali
authors.initials: A
authors.lastname: Sharma
authors.forename: Peter L
authors.initials: PL
authors.lastname: Flom
authors.forename: Jeremy
authors.initials: J
authors.lastname: Weedon
authors.forename: Robert S
authors.initials: RS
authors.lastname: Klein
mesh_terms: D000367:Age Factors; D000375:Aging / Q000502:physiology*; D015519:Bone Density / Q000187:drug effects / Q000502:physiology*; D005272:Femur Neck / Q000187:drug effects / Q000503:physiopathology; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D006615:Hip / Q000503:physiopathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000187:drug effects / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000503:physiopathology*