Low bone mass and high bone turnover in postmenopausal human immunodeficiency virus-infected women

Abstract

Context: Low bone mineral density (BMD) is commonly reported in young men and women with HIV infection, and fracture rates may be higher. With effective antiretroviral therapy (ART), the HIV population is aging. However, little is known about the skeletal status of postmenopausal women.

Objective: We aimed to assess the effects of HIV infection and ART on BMD and bone turnover in postmenopausal minority women.

Design, setting, and patients: A prospective cohort study was performed in 92 HIV+ and 95 HIV- postmenopausal Hispanic and African-American women.

Main outcome measures: We measured BMD by dual-energy x-ray absorptiometry, fracture prevalence, serum levels of inflammatory cytokines (TNFalpha, IL-6), bone turnover markers, calciotropic hormones, and estrone.

Results: HIV+ women were younger (56 +/- 1 vs. 60 +/- 1 yr; P < 0.01) and had lower BMI (28 +/- 1 vs. 30 +/- 1 kg/m(2); P < 0.01) and estrone levels. Prevalence of T scores below -1.0 was greater in HIV+ women at the spine (78 vs. 64%; P < 0.05), total hip (45 vs. 29%; P < 0.05), and femoral neck (64 vs. 46%; P < 0.05), and Z scores adjusted for BMI were lower in HIV+ women at the same sites. Serum TNFalpha, N-telopeptide, and C-telopeptide were significantly higher in HIV+ than HIV- women, particularly those receiving ART. HIV+ status was independently and negatively associated with spine and hip BMD after adjustment for age, ethnicity, BMI, and alcohol.

Conclusion: The lower BMD, higher prevalence of low BMD, and higher levels of bone turnover markers detected in HIV+ postmenopausal minority women could place them at high risk for future fractures.

Figure 1

A, Absolute BMD (grams per square centimeter) by DXA adjusted for age, race/ethnicity, and BMI in HIV− and HIV+ women. B, T scores by DXA in HIV− and HIV+ women. C, Prevalence of low BMD (T < −1.0) in HIV− and HIV+ women. D, Z scores adjusted for BMI in HIV− and HIV+ women. Adjusted comparisons of BMD at different sites are presented for HIV− (n = 95) and HIV+ (n = 92) postmenopausal minority women. In panel B, the dotted gray lines at T score = −1.0 and T score = −2.5 denote World Health Organization criteria for osteopenia and osteoporosis, respectively.

Figure 2

BTM levels in HIV− women (open) and HIV+ women (shaded) by current status of ART. Background shaded areas represent the range of normal serum levels of BAP, OC, NTx, and CTx in premenopausal women.

Figure 3

Regression of OC by CTx levels in HIV− women and HIV+ women by current ART status. Background shaded areas represent the range of normal serum levels of OC and CTx in premenopausal women.