title: Racial differences in bone loss and relation to menopause among HIV-infected and uninfected women.
abstract: OBJECTIVE
  To characterize changes in bone mineral density (BMD) according to race among HIV-infected and uninfected women, and to evaluate the relationship between race and menopause-related bone loss.
  
  
  METHODS
  Dual X-ray absorptiometry measured BMD on study entry and a minimum of 18 months later in 246 HIV-infected and 219 HIV-uninfected women in the Menopause Study. Linear regression analyses determined percent annual BMD change at the total hip (TH), femoral neck (FN), and lumbar spine (LS) after adjusting for potential confounders. Race-stratified and HIV-infected subgroup analyses were performed.
  
  
  RESULTS
  At baseline, mean age was 45 years, 19% of women were postmenopausal. HIV-infected women were more likely to be black (58% vs. 38%), and had lower BMI and less cigarette exposure when compared to HIV-uninfected women. Women who were perimenopausal at baseline and postmenopausal at follow-up had the greatest TH bone loss (-1.68%/yr, p < .0001) followed by those postmenopausal throughout (-1.02%/yr, p = .007). We found a significant interaction between HIV status and race in multivariate analyses of BMD change at the FN and TH. In race-stratified analyses, HIV infection was associated with TH BMD loss in non-black women. Black women experienced greater menopause-associated decline in TH BMD compared with non-black women.
  
  
  CONCLUSIONS
  The association of HIV and BMD differs strikingly by race, as do the effects of the menopausal transition on bone. Determining the extent to which the effect of HIV on fracture risk varies by race will be crucial to identify HIV-infected women at greatest risk for osteoporotic fracture, particularly as they enter menopause.
authors.affiliation: Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA. Electronic address: anjali.sharma@einstein.yu.edu.
authors.forename: Anjali
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Peter Flom Consulting, New York, NY, USA.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Flom
authors.affiliation: Department of Medicine, Maine Medical Center Research Institute, Scarborough, ME, USA.
authors.forename: Clifford J
authors.initials: CJ
authors.lastname: Rosen
authors.affiliation: Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Ellie E
authors.initials: EE
authors.lastname: Schoenbaum
mesh_terms: D000328:Adult; D015519:Bone Density; D016723:Bone Remodeling; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000503:physiopathology*; D018023:HIV Seronegativity; D006801:Humans; D008593:Menopause; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000208:ethnology* / Q000503:physiopathology; D044469:Racial Groups
keywords: Bone mineral density; HIV; Menopause; Osteoporosis; Race; Women