Deficits in bone strength, density and microarchitecture in women living with HIV: A cross-sectional HR-pQCT study.
PURPOSE
With the advent of combined antiretroviral therapy (cART), life expectancy has increased among persons living with HIV, but so too has risk for comorbidities including osteoporosis and fragility fracture. To explore whether HIV status and cART influence three-dimensional measures of BMD, bone microarchitecture and strength we aimed to compare these outcomes between women living with HIV (WLWH; n = 50; 50.4 ± 1.2 years, 44% postmenopausal) and without HIV (controls; n = 50; 51.8 ± 1.2 years, 52% postmenopausal).


METHODS
Outcomes were lumbar spine, total hip and femoral neck areal BMD by DXA; distal radius and tibia trabecular BMD, thickness and number, and cortical BMD and area by HR-pQCT; and finite element analysis-derived bone strength (failure load). Multivariable regression analysis compared bone outcomes between groups adjusting for known osteoporosis risk factors. Within WLWH, we examined associations between bone outcomes and HIV-related factors including disease severity and cART duration.


RESULTS
WLWH were diagnosed 20 ± 4 years ago, were on cART for 123 ± 37 months and 80% had HIV plasma viral load <40 copies/mL. For women ≥50 years (n = 61), total hip aBMD T-Score was lower among WLWH than controls. Adjusted distal radius trabecular BMD and thickness and distal tibia trabecular BMD and failure load were 8-19% lower in WLWH than controls (p < 0.05). Cortical BMD and area did not differ between groups at either site. Lifetime cART duration and current plasma viral load were not associated with bone outcomes in WLWH; however, previous treatment with tenofovir was negatively associated with distal radius trabecular BMD and trabecular number and LS aBMD T-score.


CONCLUSIONS
WLWH have compromised BMD, bone microarchitecture and strength vs. controls of similar age and reproductive status. Treatment with tenofovir may contribute to bone deficits in WLWH.
['Macdonald|Heather M|HM|', 'Maan|Evelyn J|EJ|', 'Berger|Claudie|C|', 'Dunn|Rachel A|RA|', 'Côté|Hélène C F|HCF|', 'Murray|Melanie C M|MCM|', 'Pick|Neora|N|', 'Prior|Jerilynn C|JC|']
D015502:Absorptiometry, Photon D015519:Bone Density D003430:Cross-Sectional Studies D005260:Female D015658:HIV Infections D006801:Humans D011884:Radius D013977:Tibia D014057:Tomography, X-Ray Computed
Bone strength Women HR-pQCT Areal bone mineral density Human immunodeficiency virus