High prevalence of and progression to low bone mineral density in HIV-infected patients: a longitudinal cohort study.
BACKGROUND
Low bone mineral density (BMD) is an emerging metabolic condition in HIV-infected patients; however, data on progression of this disease are scarce.


METHODS
We studied 671 patients with at least one dual-energy X-ray absorptiometry scan (391 of them ≥2 scans) to determine the prevalence and progression of BMD and establish related factors. Linear regression and logistic polytomic regression were used for the cross-sectional study and mixed effects and generalized estimating equations were used for the longitudinal study.


RESULTS
Osteopenia and osteoporosis were diagnosed in 47.5 and 23%, respectively. Progression to bone demineralization was observed in 28% of the patients over a median of 2.5 years (12.5% progressed to osteopenia and 15.6% to osteoporosis). In the 105 patients with at least 5 years of follow-up, progression was 47% (18% to osteopenia; 29% to osteoporosis). Factors associated with bone loss and progression were age [odds ratio (OR) 1.07; 95% confidence interval (CI) 1.05-1.08; P < 0.0001], male sex (OR 2.23; 95% CI 1.77-2.8; P < 0.0001), low body mass index (OR 1.14; 95% CI 1.11-1.17; P < 0.0001), time on protease inhibitor (OR 1.18; 95% CI 1.12-1.24; P < 0.0001), time on tenofovir (OR 1.08; 95% CI 1.03-1.14; P < 0.0019), and current use of protease inhibitors (OR 1.64; 95% CI 1.35-2.04; P < 0.0001).


CONCLUSIONS
Our results show a high prevalence of and considerable progression to osteopenia/osteoporosis in our cohort. Our findings support the importance of applying adequate strategies to prevent bone demineralization and of close monitoring of BMD in HIV-infected patients, specifically in at-risk patients who are taking antiretrovirals that affect bone mineralization.
Lluita contra la SIDA Foundation, University Hospital Germans Trias, Barcelona, Spain. abonjoch@flsida.org
Anna
A
Bonjoch
Marta
M
Figueras
Carla
C
Estany
Núria
N
Perez-Alvarez
Joaquim
J
Rosales
Luís
L
del Rio
Silvana
S
di Gregorio
Jordi
J
Puig
Guadalupe
G
Gómez
Bonaventura
B
Clotet
Eugènia
E
Negredo
D015502:Absorptiometry, Photon; D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives*; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D015519:Bone Density / Q000187:drug effects*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000009:adverse effects*; D010024:Osteoporosis / Q000139:chemically induced* / Q000000981:diagnostic imaging; D015995:Prevalence; D011877:Radionuclide Imaging; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects*; D012307:Risk Factors; D000068698:Tenofovir
D063065:Organophosphonates; D018894:Reverse Transcriptase Inhibitors; D000068698:Tenofovir; D000225:Adenine