title: Changes in bone mineral density over a 2-year period in HIV-1-infected men under combined antiretroviral therapy with osteopenia.
abstract: OBJECTIVE
  Although osteopenia is common in HIV-infected patients, there is by now limited data on the evolution of bone mineral density in this population. We aimed to evaluate the course of osteopenia over a 2-year period in HIV-1-infected men, and to identify risk factors for abnormal bone mineral density (BMD) decline.
  
  
  METHODS
  HIV-1-infected men on combined antiretroviral therapy (cART) screened in the ANRS 120 Fosivir trial, diagnosed with low BMD (-2.5 ≤T-score <-1), not receiving antiosteoporotic agents, with sequential dual-energy-X ray-absorptiometry (DXA) available at baseline were eligible for this study and had a second DXA performed between months 24 and 36.
  
  
  RESULTS
  We enrolled 94 men with a median age of 46 years [interquartile range (IQR), 41-53], BMI 22 kg/m² (21-25) and a CD4 cell nadir of 164/μl (69-261). They were receiving cART for a median of 7.5 years (5.8-9.5). Over a median interval of 2.6 years (2.3-2.9) between the two DXA tests, the mean change in BMD was -0.5 ± 1.7% per year (P = 0.010) at the lumbar spine and -0.4 ± 1.8% per year (P = 0.033) at the hip. BMD fell by more than the smallest detectable difference (SDD) in, respectively, 25.5 and 27.7% of patients at the lumbar spine and hip. Tenofovir (TDF) exposure was independently associated with a larger decline in BMD at both sites [lumbar spine, OR = 2.4 (1.2-4.9); hip, OR = 2.8 (1.3-5.9)].
  
  
  CONCLUSIONS
  Although osteopenia overall modestly changes over 2 years in long-term cART-treated patients, a quarter of patients experienced a significant loss (>1 SDD) associated with TDF exposure.
authors.affiliation: aINSERM bUPMC Univ Paris 06, UMRS 943 cAP-HP, Hôpital Pitié-Salpêtrière, Service de Maladies Infectieuses et Tropicales dAP-HP, Centre de Diagnostic et de Thérapeutique, Hôtel-Dieu, Paris eAP-HP, Hôpital Avicenne, Service de maladies infectieuses, Bobigny fAP-HP, Hôpital Pitié-Salpêtrière, Service de médecines internes gRheumatology Department, Cochin Hospital, Paris-Descartes University hAP-HP, Hôpital Pitié-Salpêtrière, Service de Rhumatologie and UPMC Univ Paris 06, Paris, France.
authors.forename: Lambert
authors.initials: L
authors.lastname: Assoumou
authors.forename: Christine
authors.initials: C
authors.lastname: Katlama
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Viard
authors.forename: Michelle
authors.initials: M
authors.lastname: Bentata
authors.forename: Anne
authors.initials: A
authors.lastname: Simon
authors.forename: Christian
authors.initials: C
authors.lastname: Roux
authors.forename: Sami
authors.initials: S
authors.lastname: Kolta
authors.forename: Dominique
authors.initials: D
authors.lastname: Costagliola
authors.forename: Sylvie
authors.initials: S
authors.lastname: Rozenberg
mesh_terms: D015502:Absorptiometry, Photon; D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects; D044966:Anti-Retroviral Agents / Q000009:adverse effects*; D015519:Bone Density / Q000187:drug effects*; D001851:Bone Diseases, Metabolic / Q000139:chemically induced* / Q000150:complications; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D015497:HIV-1; D006615:Hip / Q000000981:diagnostic imaging; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000009:adverse effects; D012307:Risk Factors; D000068698:Tenofovir
chemical_list: D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents; D063065:Organophosphonates; D000068698:Tenofovir; D000225:Adenine