Microstructural alterations of trabecular and cortical bone in long-term HIV-infected elderly men on successful antiretroviral therapy.
OBJECTIVE
Progress in antiretroviral therapy (ART) has resulted in an almost normal life expectancy for HIV-infected individuals, but an increased risk of fragility fractures has been identified. We investigated the influence of long-term HIV infection on successful ART on bone microstructure in elderly men.


METHODS
A cross-sectional, case–control study.


METHODS
Dual-energy X-ray absorptiometry (DXA) and high-resolution peripheral quantitative computed tomography (HR-pQCT) were performed in 28 HIV-positive men between 60 and 70 years old on successful ART. Controls were 112 HIV-negative men matched for age 4 years and BMI (4 kg/ m²).


RESULTS
HIV-positive men (median CD4þ cell count, 589 cells/ml; BMI, 24.8 kg/m²) had a median duration of HIV infection of 18.2 years. Compared with HIV-negative men, they had a lower DXA-measured areal bone mineral density at total hip (3.2%, P¼0.050) and ultra-distal radius (8.4%, P¼0.001). At distal radius and tibia, we observed microstructural alterations with a lower total density (16%, P¼ 0.005 and 14.3%, P¼ 0.039), trabecular density (11.6%, P¼ 0.012 and 12.2%, P¼ 0.007) and cortical area (17.5%, P¼ 0.002 and 12.2%, P¼ 0.01). In addition, they had a lower trabecular number (P¼ 0.036), higher trabecular spacing (P¼ 0.027) and lower cortical thickness (19.9%; P¼ 0.008) at distal radius. beta-crosslaps (CTX) and vitamin D levels were higher than in controls. By multivariate analyses, HIV status, higher CTX levels, lower physical activity and estradiol levels were determinants of bone density and microstructure alterations.


CONCLUSIONS
HIV-infected elderly men on successful ART have trabecular and cortical bone microstructure alterations associated with higher bone resorption, despite adequate vitamin D supplementation.
Emmanuel
E
Biver
Alexandra
A
Calmy
Cecile
C
Delhumeau
Claire
C
Durosier
Sophie
S
Zawadynski
Rene
R
Rizzoli
D015502:Absorptiometry, Photon; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D015519:Bone Density; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000502:physiology*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
D044966:Anti-Retroviral Agents