title: High prevalence of radiological vertebral fractures in HIV-infected males.
abstract: Age-related co-morbidities including osteoporosis are relevant in patients responding to combination antiretroviral therapy (cART). Vertebral fractures are common osteoporotic fractures and their diagnosis is useful for managing at-risk individuals. However, there are few data from HIV-infected patients. Therefore, the aim of this study was to determine the prevalence of and factors associated with vertebral fractures in a population of HIV-infected males. A cross-sectional study of 160 HIV-infected patients with available chest X-rays was conducted from 1998 to 2010. One hundred and sixty-three males with comparable age and with no history of HIV infection were recruited as controls. Semi-quantitative evaluation of vertebral heights in lateral chest X-rays and quantitative morphometry assessment of centrally digitized images using dedicated morphometry software were utilized to detect prevalent vertebral fractures. The result showed that the vertebral fractures were detected in 43/160 (26.9%) HIV-infected patients and in 21/163 (12.9%) controls (P = 0.002). In HIV-infected patients with fractures, 27 had two or more fractures and ten patients had severe fractures. The prevalence of any fractures and multiple fractures in HIV-infected patients receiving cART (29.6 and 20.0%) was slightly higher than in HIV-infected patients not exposed to cART (17.1 and 5.7%), but significantly higher than control subjects (12.9 and 3.7%). At multivariable analyses, body mass index and diabetes mellitus were independently correlated with vertebral fractures in HIV-infected patients. We concluded that a significant proportion of HIV-infected males receiving cART showed vertebral fractures. Furthermore, proactive diagnosis of vertebral fragility fractures is particularly relevant in patients who are overweight or suffer from diabetes.
authors.affiliation: Institute of Infectious and Tropical Diseases, School of Medicine, University of Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy. torti@med.unibs.it
authors.forename: Carlo
authors.initials: C
authors.lastname: Torti
authors.forename: Gherardo
authors.initials: G
authors.lastname: Mazziotti
authors.forename: Pier Antonio
authors.initials: PA
authors.lastname: Soldini
authors.forename: Emanuele
authors.initials: E
authors.lastname: Focà
authors.forename: Roberto
authors.initials: R
authors.lastname: Maroldi
authors.forename: Daria
authors.initials: D
authors.lastname: Gotti
authors.forename: Giampiero
authors.initials: G
authors.lastname: Carosi
authors.forename: Andrea
authors.initials: A
authors.lastname: Giustina
mesh_terms: D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000627:therapeutic use; D015992:Body Mass Index; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D004359:Drug Therapy, Combination / Q000009:adverse effects; D057286:Electronic Health Records; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000453:epidemiology; D015995:Prevalence; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016103:Spinal Fractures / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000187:drug effects / Q000293:injuries* / Q000473:pathology
chemical_list: D044966:Anti-Retroviral Agents