title: Higher rates of bone loss in postmenopausal HIV-infected women: a longitudinal study.
abstract: OBJECTIVE
  The objective of the study was to assess the effects of HIV infection and antiretroviral therapy on change in bone mineral density (BMD) in postmenopausal minority women.
  
  
  METHODS
  We report a longitudinal analysis of change in BMD with a median duration of 15.4 (interquartile range 13.1, 20.7) months in a prospective cohort study of 128 (73 HIV+, 55 HIV-) postmenopausal Hispanic and African-American women.
  
  
  METHODS
  Annualized change in BMD by dual-energy x-ray absorptiometry and correlation with baseline markers of bone turnover and serum levels of inflammatory cytokines were measured.
  
  
  RESULTS
  HIV+ women were younger (56 ± 1 vs. 59 ± 1 yr, P < 0.05) and had lower body mass index (BMI; 28 ± 1 vs. 31 ± 1 kg/m(2), P < 0.01). The majority of HIV+ women were on established antiretroviral therapy for more than 3 yr. At baseline, BMD, adjusted for age, race, and BMI, was lower in HIV+ women at the lumbar spine (LS), total hip, and radius and serum C-telopeptide was higher. Annualized rates of bone loss adjusted for baseline BMD were higher in HIV+ women by 2.4-fold at the LS (-1.2 ± 0.3% vs. -0.5 ± 0.3%, P = 0.0009), 3.7-fold at the one third radius (-1.1 ± 0.2% vs. -0.3 ± 0.2, P = 0.006) and 1.7-fold at the ultradistal radius (-1.2 ± 0.2% vs. -0.7 ± 0.2%, P = 0.02). In multivariate analysis, HIV+ status predicted bone loss at the LS, total hip, and ultradistal radius. Among HIV+ women, lower BMI, higher markers of bone turnover levels, and tenofovir were associated with more bone loss.
  
  
  CONCLUSIONS
  HIV+ postmenopausal minority women had lower BMD, increased bone turnover, and higher rates of bone loss than HIV- women. These features may place these women at increased risk for fracture as they age.
authors.affiliation: Columbia University Medical Center, New York, New York 10032, USA. mty4@columbia.edu
authors.forename: Michael T
authors.initials: MT
authors.lastname: Yin
authors.forename: Chiyuan A
authors.initials: CA
authors.lastname: Zhang
authors.forename: Donald J
authors.initials: DJ
authors.lastname: McMahon
authors.forename: David C
authors.initials: DC
authors.lastname: Ferris
authors.forename: Dinaz
authors.initials: D
authors.lastname: Irani
authors.forename: Ivelisse
authors.initials: I
authors.lastname: Colon
authors.forename: Serge
authors.initials: S
authors.lastname: Cremers
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Shane
mesh_terms: D015502:Absorptiometry, Photon; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D015519:Bone Density / Q000502:physiology; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000097:blood / Q000150:complications* / Q000453:epidemiology / Q000378:metabolism; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D009819:Office Visits; D015663:Osteoporosis, Postmenopausal / Q000097:blood / Q000150:complications* / Q000453:epidemiology / Q000378:metabolism; D013997:Time Factors
chemical_list: D015415:Biomarkers
references.citation: Nat Med. 2006 Dec;12(12):1365-71
references.pmid: 17115046
references.citation: J Bone Miner Res. 2005 Nov;20(11):1929-35
references.pmid: 16234965
references.citation: J Clin Endocrinol Metab. 2006 Aug;91(8):2938-45
references.pmid: 16735489
references.citation: AIDS. 2010 Nov 13;24(17):2679-86
references.pmid: 20859192
references.citation: Annu Rev Immunol. 2003;21:265-304
references.pmid: 12524385
references.citation: J Acquir Immune Defic Syndr. 2009 Aug 15;51(5):554-61
references.pmid: 19512937
references.citation: Clin Infect Dis. 2010 Oct 15;51(8):963-72
references.pmid: 20828304
references.citation: Clin Infect Dis. 2006 Apr 1;42(7):1014-20
references.pmid: 16511769
references.citation: Clin Endocrinol (Oxf). 2007 Aug;67(2):270-5
references.pmid: 17547686
references.citation: J Clin Densitom. 2001 Winter;4(4):373-80
references.pmid: 11748342
references.citation: J Clin Endocrinol Metab. 2011 Sep;96(9):2721-31
references.pmid: 21715534
references.citation: J Infect Dis. 2011 Jun 15;203(12):1791-801
references.pmid: 21606537
references.citation: J Clin Endocrinol Metab. 2010 Feb;95(2):620-9
references.pmid: 19965927
references.citation: Clin Infect Dis. 2008 Aug 15;47(4):542-53
references.pmid: 18627268
references.citation: J Infect. 2003 May;46(4):221-7
references.pmid: 12799147
references.citation: AIDS. 2007 Mar 12;21(5):617-23
references.pmid: 17314524
references.citation: J Clin Endocrinol Metab. 2008 Sep;93(9):3499-504
references.pmid: 18593764
references.citation: Clin Infect Dis. 2003 Feb 15;36(4):482-90
references.pmid: 12567307
references.citation: AIDS. 2004 Feb 20;18(3):475-83
references.pmid: 15090800
references.citation: Osteoporos Int. 2008 Jul;19(7):913-8
references.pmid: 18071649
references.citation: AIDS. 2003 Sep 5;17(13):1917-23
references.pmid: 12960824
references.citation: JAMA. 2004 Jul 14;292(2):191-201
references.pmid: 15249568
references.citation: J Bone Miner Res. 1996 Aug;11(8):1043-51
references.pmid: 8854239
references.citation: Bone. 2009 May;44(5):734-43
references.pmid: 19195497
references.citation: Lancet. 2002 Jun 1;359(9321):1929-36
references.pmid: 12057569
references.citation: Arch Intern Med. 2006 Jun 12;166(11):1225-31
references.pmid: 16772251
references.citation: Curr Infect Dis Rep. 2006 Mar;8(2):162-70
references.pmid: 16524553
references.citation: AIDS. 2001 Jul 6;15(10):1275-80
references.pmid: 11426072
references.citation: Clin Geriatr Med. 2007 Aug;23(3):567-83, vii
references.pmid: 17631234
references.citation: AIDS. 2001 Apr 13;15(6):807-8
references.pmid: 11371701
references.citation: J Acquir Immune Defic Syndr. 2010 Feb;53(2):202-8
references.pmid: 19890216
references.citation: AIDS. 2001 Apr 13;15(6):703-9
references.pmid: 11371684
references.citation: J Bone Miner Res. 2004 Aug;19(8):1215-20
references.pmid: 15231007
references.citation: Clin Endocrinol (Oxf). 2006 Aug;65(2):191-7
references.pmid: 16886959
references.citation: HIV Med. 2004 Jan;5(1):55-65
references.pmid: 14731171
references.citation: AIDS. 2000 Mar 10;14(4):F63-7
references.pmid: 10770534
references.citation: AIDS. 2010 Nov 27;24(18):2827-33
references.pmid: 21045635
references.citation: HIV Med. 2011 Mar;12(3):157-65
references.pmid: 20722752
references.citation: J Infect Dis. 2003 May 15;187(10):1534-43
references.pmid: 12721933
references.citation: Osteoporos Int. 2011 Feb;22(2):477-87
references.pmid: 20585939
references.citation: HIV Clin Trials. 2003 Sep-Oct;4(5):337-46
references.pmid: 14583850
references.citation: AIDS. 2009 Apr 27;23(7):817-24
references.pmid: 19363330
references.citation: Clin Infect Dis. 2007 Dec 15;45(12):1593-601
references.pmid: 18190322
references.citation: HIV Clin Trials. 2007 May-Jun;8(3):164-72
references.pmid: 17621463