title: Decreased serum bone specific alkaline phosphatase and increased urinary N-terminal telopeptide of type I collagen as prognostic markers for bone mineral density loss in HIV patients on cART.
abstract: OBJECTIVE
  Bone mineral density (BMD) loss is a major chronic complication in HIV patients. We performed a prospective study to determine the time course of BMD changes and to find prognostic factors of BMD loss in HIV patients on combination antiretroviral therapy (cART).
  
  
  METHODS
  Subjects were 54 male Japanese HIV patients who had been on cART ≥1 year with no therapeutic agents for osteoporosis. Patients were observed for ≥1 year (median 3.1 years) and underwent annual BMD analyses using dual energy X-ray absorptiometry. Changes in BMD at lumbar spine and femoral neck were calculated for each person-year of all the patients. Clinical factors were also collected simultaneously with BMD examinations to determine prognostic factors for BMD loss.
  
  
  RESULTS
  In total, 173 person-years in 54 patients were observed. One third (19, 35.2%) and slightly over half (30, 55.6%) patients showed BMD decreases at lumbar spine and femoral neck, respectively. However, the median BMD changes at lumbar spine and femoral neck were 0.0% and -0.52% per year, respectively. Monovariant and mixed model analyses determined that decreased serum bone specific alkaline phosphatase (BAP, p = 0.0047) and increased urinary N-terminal telopeptide (uNTx, p = 0.0011) were prognostic factors for BMD loss at lumbar spine and femoral neck, respectively.
  
  
  CONCLUSIONS
  BMD at both lumbar spine and femoral neck changed little on average in HIV patients on cART. Decreased serum BAP or increased uNTx may be helpful to predict progressive BMD loss in the following year and to select patients for BMD follow-up or initiation of anti-osteoporosis treatment.
authors.affiliation: Department of Infectious Diseases, Teikyo University School of Medicine, Tokyo, Japan. Electronic address: koga@med.teikyo-u.ac.jp.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Koga
authors.affiliation: Department of Infectious Diseases, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Seo
authors.affiliation: Department of Infectious Diseases, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yoshino
authors.affiliation: Department of Infectious Diseases, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Kitazawa
authors.affiliation: Data Innovation Center, iAnalysis, Inc., Delaware, USA.
authors.forename: Issei
authors.initials: I
authors.lastname: Kurahashi
authors.affiliation: Department of Infectious Diseases, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ota
mesh_terms: D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D044466:Asian People; D015415:Biomarkers / Q000097:blood* / Q000652:urine*; D015519:Bone Density / Q000502:physiology; D024042:Collagen Type I / Q000652:urine*; D005272:Femur Neck / Q000473:pathology; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000473:pathology* / Q000652:urine; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000097:blood / Q000473:pathology / Q000652:urine / Q000821:virology; D011379:Prognosis; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D015415:Biomarkers; D024042:Collagen Type I; D000469:Alkaline Phosphatase
keywords: Bone mineral density (BMD); Bone specific alkaline phosphatase (BAP); HIV; Urinary N-terminal telopeptide of type I collagen (NTx)