title: Prevalence and predictors of low bone mineral density and fragility fractures among HIV-infected patients at one Italian center after universal DXA screening: sensitivity and specificity of current guidelines on bone mineral density management.
abstract: Low bone mineral density (BMD) is frequent in HIV infection regardless of the use of antiretroviral therapy (ART). Uncertainties remain, however, as to when in HIV infection BMD screening should be performed. We designed a prospective study to estimate the efficacy of universal BMD screening by dual-energy X-ray absorptiometry (DXA). Since April 2009 through March 2011, HIV patients attending our Center were offered femoral/lumbar DXA to screen BMD. Low BMD for chronological age, that is significant osteopenia, was defined as a Z-score ≤ -2.0 at femur and lumbar spine. Nontraumatic bone fractures (NTBFs) were evaluated. The final sample included 163 patients. A Z-score ≤ -2.0 at any site was observed in 19.6% of cases: among these, 18.8% had no indication to DXA using current Italian HIV guidelines for BMD screening. A lower femoral Z-score was independently associated with lower BMI, AIDS diagnosis, HCV co-infection, antiretroviral treatment, and NTBFs; a lower lumbar Z-score with age, BMI, Nadir CD4 T-cell counts, and NTBFs. Prevalence of NTBFs was 27.0%, predictors being male gender, HCV co-infection, and lower femoral Z-scores. Our results suggest that measuring BMD by DXA in all HIV patients regardless of any further specification may help retrieving one-fifth of patients with early BMD disorders not identified using current criteria for selective screening of BMD.
authors.affiliation: 1 University of Chieti "Gabriele D'Annunzio" , Chieti, Italy .
authors.forename: Elena
authors.initials: E
authors.lastname: Mazzotta
authors.forename: Tamara
authors.initials: T
authors.lastname: Ursini
authors.forename: Adriana
authors.initials: A
authors.lastname: Agostinone
authors.forename: Angelo Domenico
authors.initials: AD
authors.lastname: Di Nicola
authors.forename: Ennio
authors.initials: E
authors.lastname: Polilli
authors.forename: Federica
authors.initials: F
authors.lastname: Sozio
authors.forename: Francesco
authors.initials: F
authors.lastname: Vadini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pieri
authors.forename: Francesca
authors.initials: F
authors.lastname: Trave
authors.forename: Valerio
authors.initials: V
authors.lastname: De Francesco
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Capasso
authors.forename: Marco
authors.initials: M
authors.lastname: Borderi
authors.forename: Lamberto
authors.initials: L
authors.lastname: Manzoli
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Viale
authors.forename: Giustino
authors.initials: G
authors.lastname: Parruti
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D015519:Bone Density / Q000187:drug effects; D001851:Bone Diseases, Metabolic / Q000453:epidemiology* / Q000209:etiology; D015496:CD4-Positive T-Lymphocytes; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007558:Italy; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011446:Prospective Studies; D012680:Sensitivity and Specificity