title: Association of osteonecrosis and osteoporosis in HIV-1-infected patients.
abstract: BACKGROUND
  We questioned whether heightened impairment of regenerative capacity of osteoblasts might account for the excess of osteonecrosis and osteoporosis seen in HIV-infected patients. Were that the case, patients with osteonecrosis would have more osteoporosis than the patients without osteonecrosis.
  
  
  METHODS
  Eleven thousand, five hundred and six patients with HIV infection were studied for the presence of osteonecrosis and osteoporosis and for confounding factors.
  
  
  RESULTS
  Depending upon whether dual-energy X-ray absorptiometry (DEXA) was before or after the diagnosis of osteonecrosis, osteoporosis was between 6.3 and 18 times more frequent in those with than in those without osteonecrosis. Those who received DEXA were similar to those who did not in median CD4 level at the time of DEXA or at a comparable time after their first recorded CD4 cell count in our system; in nadir CD4 level; and in use and amount of corticosteroids. Those with osteonecrosis and osteoporosis did not use more corticosteroids than those with osteoporosis without osteonecrosis. Alcohol abuse had not been diagnosed more often before the occurrence of osteonecrosis than in those without osteonecrosis. Tenofovir was not more used by those with than by those without osteoporosis.
  
  
  CONCLUSIONS
  Osteonecrosis and osteoporosis in HIV-infected patients were concurrent more often than expected.
authors.affiliation: Kaiser Permanente Medical Care Program, Clinical Trials Unit, San Francisco, California 94115, USA. jeffrey.fessel@kp.org
authors.forename: W Jeffrey
authors.initials: WJ
authors.lastname: Fessel
authors.forename: Quyen
authors.initials: Q
authors.lastname: Chau
authors.forename: Davis
authors.initials: D
authors.lastname: Leong
mesh_terms: D015502:Absorptiometry, Photon; D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives*; D000428:Alcohol Drinking / Q000009:adverse effects; D019380:Anti-HIV Agents / Q000009:adverse effects*; D002140:California / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000009:adverse effects*; D010020:Osteonecrosis / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D010024:Osteoporosis / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D011239:Prednisolone / Q000009:adverse effects*; D000068698:Tenofovir
chemical_list: D019380:Anti-HIV Agents; D063065:Organophosphonates; D000068698:Tenofovir; D011239:Prednisolone; D000225:Adenine