title: Low bone mineral density in patients with well-suppressed HIV infection: association with body weight, smoking, and prior advanced HIV disease.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV) and combination antiretroviral therapy (cART) may both contribute to the higher prevalence of osteoporosis and osteopenia in HIV-infected individuals.
  
  
  METHODS
  Using dual-energy X-ray absorptiometry, we compared lumbar spine, total hip, and femoral neck bone mineral density (BMD) in 581 HIV-positive (94.7% receiving cART) and 520 HIV-negative participants of the AGEhIV Cohort Study, aged ≥45 years. We used multivariable linear regression to investigate independent associations between HIV, HIV disease characteristics, ART, and BMD.
  
  
  RESULTS
  The study population largely consisted of men who have sex with men (MSM). Osteoporosis was significantly more prevalent in those with HIV infection (13.3% vs 6.7%; P<.001). After adjustment for body weight and smoking, being HIV-positive was no longer independently associated with BMD. Low body weight was more strongly negatively associated with BMD in HIV-positive persons with a history of a Centers for Disease Control and Prevention class B or C event. Interestingly, regardless of HIV status, younger MSM had significantly lower BMD than older MSM, heterosexual men, and women.
  
  
  CONCLUSIONS
  The observed lower BMD in treated HIV-positive individuals was largely explained by both lower body weight and more smoking. Having experienced symptomatic HIV disease, often associated with weight loss, was another risk factor. The low BMD observed in younger MSM remains unexplained and needs further study.
authors.affiliation: Department of Global Health, Academic Medical Center and Amsterdam Institute for Global Health and Development.
authors.forename: Katherine W
authors.initials: KW
authors.lastname: Kooij
authors.affiliation: Department of Global Health, Academic Medical Center and Amsterdam Institute for Global Health and Development Division of Infectious Diseases and Center for Infection and Immunity Amsterdam (CINIMA).
authors.forename: Ferdinand W N M
authors.initials: FW
authors.lastname: Wit
authors.affiliation: Department of Endocrinology and Metabolism.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Bisschop
authors.affiliation: Department of Global Health, Academic Medical Center and Amsterdam Institute for Global Health and Development Department of Neurology.
authors.forename: Judith
authors.initials: J
authors.lastname: Schouten
authors.affiliation: Division of Infectious Diseases and Center for Infection and Immunity Amsterdam (CINIMA) Public Health Service Amsterdam, Infectious Diseases Research.
authors.forename: Ineke G
authors.initials: IG
authors.lastname: Stolte
authors.affiliation: Division of Infectious Diseases and Center for Infection and Immunity Amsterdam (CINIMA) Public Health Service Amsterdam, Infectious Diseases Research.
authors.forename: Maria
authors.initials: M
authors.lastname: Prins
authors.affiliation: Division of Infectious Diseases and Center for Infection and Immunity Amsterdam (CINIMA).
authors.forename: Marc
authors.initials: M
authors.lastname: van der Valk
authors.affiliation: Division of Infectious Diseases and Center for Infection and Immunity Amsterdam (CINIMA).
authors.forename: Jan M
authors.initials: JM
authors.lastname: Prins
authors.affiliation: Department of Nuclear Medicine, Academic Medical Center.
authors.forename: Berthe L F
authors.initials: BL
authors.lastname: van Eck-Smit
authors.affiliation: Department of Internal Medicine/Endocrinology, VU University Medical Center.
authors.forename: Paul
authors.initials: P
authors.lastname: Lips
authors.affiliation: Department of Global Health, Academic Medical Center and Amsterdam Institute for Global Health and Development Division of Infectious Diseases and Center for Infection and Immunity Amsterdam (CINIMA) Stichting HIV Monitoring, Amsterdam, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
mesh_terms: D001835:Body Weight / Q000502:physiology*; D015519:Bone Density / Q000502:physiology*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology*; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010024:Osteoporosis / Q000150:complications* / Q000453:epidemiology; D011446:Prospective Studies; D012907:Smoking / Q000453:epidemiology*
keywords: HIV; body weight; bone mineral density; men who have sex with men; osteopenia; osteoporosis