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Low bone mineral density, renal dysfunction, and fracture risk in HIV infection: a cross-sectional study

Fux, C. A.
Norris, Richard
Vallier, Nathalie
Delhumeau, Cecile
Samaras, Katherine
Hesse, Karl
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Published in The Journal of Infectious Diseases. 2009, vol. 200, no. 11, p. 1746-1754
Abstract BACKGROUND: Reduced bone mineral density (BMD) is common in adults infected with human immunodeficiency virus (HIV). The role of proximal renal tubular dysfunction (PRTD) and alterations in bone metabolism in HIV-related low BMD are incompletely understood. METHODS: We quantified BMD (dual-energy x-ray absorptiometry), blood and urinary markers of bone metabolism and renal function, and risk factors for low BMD (hip or spine T score, -1 or less) in an ambulatory care setting. We determined factors associated with low BMD and calculated 10-year fracture risks using the World Health Organization FRAX equation. RESULTS: We studied 153 adults (98% men; median age, 48 years; median body mass index, 24.5; 67 [44%] were receiving tenofovir, 81 [53%] were receiving a boosted protease inhibitor [PI]). Sixty-five participants (42%) had low BMD, and 11 (7%) had PRTD. PI therapy was associated with low BMD in multivariable analysis (odds ratio, 2.69; 95% confidence interval, 1.09-6.63). Tenofovir use was associated with increased osteoblast and osteoclast activity (P< or =.002). The mean estimated 10-year risks were 1.2% for hip fracture and 5.4% for any major osteoporotic fracture. CONCLUSIONS: In this mostly male population, low BMD was significantly associated with PI therapy. Tenofovir recipients showed evidence of increased bone turnover. Measurement of BMD and estimation of fracture risk may be warranted in treated HIV-infected adults.
Keywords AdultAnalysis of VarianceAnti-Retroviral Agents/therapeutic useBone DensityCross-Sectional StudiesFanconi Syndrome/metabolism/pathology/ virologyFemaleFractures, Bone/metabolism/ virologyHIV Infections/drug therapy/ metabolism/pathologyHumansLogistic ModelsMaleMiddle AgedPrevalenceRisk FactorsStatistics, Nonparametric
PMID: 19874178
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Research group Unité HIV (46)
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CALMY, Alexandra et al. Low bone mineral density, renal dysfunction, and fracture risk in HIV infection: a cross-sectional study. In: The Journal of Infectious Diseases, 2009, vol. 200, n° 11, p. 1746-1754. https://archive-ouverte.unige.ch/unige:7131

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Deposited on : 2010-06-21

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