title: Assessment of radiological vertebral fractures in HIV-infected patients: clinical implications and predictive factors.
abstract: OBJECTIVE
  The aim of this study was to evaluate the clinical impact of including lateral spine X-ray in the screening of bone diseases in HIV-positive patients.
  
  
  METHODS
  A total of 194 HIV-positive patients underwent dual-energy X-ray absorptiometry (DEXA), lateral spine X-ray and bone biochemical analysis. Vertebral fractures were identified using a morphometric analysis of X-rays and classified using the semiquantitative scoring system of Genant et al. For each patient, a spine deformity index (SDI) score was calculated by summing the grades of vertebral deformities. Reductions in vertebral body height of > 25% were considered vertebral fractures, and those < 25% were considered vertebral deformities. Risk factors associated with vertebral fractures were evaluated by univariate and multivariate analysis.
  
  
  RESULTS
  Vertebral fractures were detected in 24 patients (12.4%) and vertebral deformities in 17 patients (8.7%); 153 patients (78.9%) did not show any vertebral deformity. Among patients with fractures, only two with SDI > 10 reported lumbar pain; the remaining were asymptomatic. Patients over 50 years old showed a higher prevalence of vertebral fracture [24.4% versus 11.8% in patients 41-50 years old (P = 0.05) and 1.9% in patients ≤ 40 years old (P = 0.04)]. No significant increase in the prevalence according to bone mineral density (BMD) reduction was observed, and 70% of fractures were diagnosed in nonosteoporotic patients. Older age [adjusted odds ratio 1.09; 95% confidence interval (CI) 1.03-1.13; P = 0.001] and steroid use (adjusted odds ratio 3.64; 95% CI 1.29-10.3; P = 0.01) were independently associated with vertebral fracture; no association was found with HIV- or highly active antiretroviral therapy (HAART)-related variables.
  
  
  CONCLUSIONS
  A prevalence of vertebral fractures of 12.4% was observed in our HIV-positive cohort. Given that two-thirds of fractures occurred in nonosteoporotic patients, spine X-ray may be considered in patients at increased risk, irrespective of BMD; that is, in elderly patients and/or patients using steroids.
authors.affiliation: Department of Health Sciences, Clinic of Infectious Diseases, 'San Paolo' Hospital, University of Milan, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Gazzola
authors.affiliation: Department of Health Sciences, Clinic of Infectious Diseases, 'San Paolo' Hospital, University of Milan, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Savoldi
authors.affiliation: Department of Health Sciences, Clinic of Infectious Diseases, 'San Paolo' Hospital, University of Milan, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Bai
authors.affiliation: Department of Radiology, 'San Paolo' Hospital, University of Milan, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Magenta
authors.affiliation: Orthopedic Clinic, 'San Paolo' Hospital, University of Milan, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Dziubak
authors.affiliation: Orthopedic Clinic, 'San Paolo' Hospital, University of Milan, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Pietrogrande
authors.affiliation: Department of Biomedical Sciences and Technologies and Center of Molecular and Cellular Imaging, 'San Paolo' Hospital, University of Milan, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Tagliabue
authors.affiliation: Department of Biomedical Sciences and Technologies and Center of Molecular and Cellular Imaging, 'San Paolo' Hospital, University of Milan, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Del Sole
authors.affiliation: Department of Health Sciences, Clinic of Infectious Diseases, 'San Paolo' Hospital, University of Milan, Milan, Italy.
authors.forename: T
authors.initials: T
authors.lastname: Bini
authors.affiliation: Department of Health Sciences, Clinic of Infectious Diseases, 'San Paolo' Hospital, University of Milan, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Marchetti
authors.affiliation: Department of Health Sciences, Clinic of Infectious Diseases, 'San Paolo' Hospital, University of Milan, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: d'Arminio Monforte
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000328:Adult; D015519:Bone Density; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology*
keywords: HIV infection; osteoporosis; vertebral fractures