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Reduced bone mineral density in human immunodeficiency virus-infected patients and its association with increased

Todd T Brown1, Mary D Ruppe, Rory Kassner

  • 1Department of Medicine, Georgetown University Medical Center, Washington, DC 20007, USA. tbrown27@jhmi.edu

The Journal of Clinical Endocrinology and Metabolism
|March 6, 2004
PubMed

Insights

Highly active antiretroviral therapy (HAART) is linked to reduced bone mineral density (BMD) in HIV patients. Central adiposity and hyperglycemia correlate with lower BMD, while female gender and dyslipidemia are associated with increased bone resorption.

Area of Science:

  • Endocrinology
  • Metabolic Syndrome
  • Bone Metabolism

Background:

  • Highly active antiretroviral therapy (HAART) is associated with metabolic complications, including fat redistribution, glucose homeostasis, and lipid metabolism abnormalities.
  • Reduced bone mineral density (BMD) is also prevalent in HIV-infected patients on HAART, but the relationship between metabolic and skeletal complications remains unclear.

Purpose of the Study:

  • To investigate the association between metabolic abnormalities and reduced bone mineral density (BMD) in HIV-infected patients receiving HAART.
  • To identify factors associated with increased bone resorption in this population.

Main Methods:

  • Cross-sectional study comparing 51 HIV patients on HAART with 21 HIV-negative controls.
  • Evaluations included oral glucose tolerance testing, fasting lipid profile, dual-energy X-ray absorptiometry (DXA) for BMD, and bone turnover markers (serum osteocalcin, urinary deoxypyridinoline).

Main Results:

  • HIV-infected subjects showed a higher prevalence of osteopenia or osteoporosis (63% vs. 32%, P=0.02) and increased bone resorption (P=0.012).
  • Reduced BMD in HIV patients was associated with postload hyperglycemia (OR 1.02 per 1 mg/dl increase, P=0.009) and central adiposity (OR 1.09 per 1% ratio increase, P=0.012).
  • Bone resorption was independently associated with female gender (P<0.001) and non-HDL cholesterol (P=0.034).

Conclusions:

  • Reduced BMD is common in HIV patients on HAART and is linked to central adiposity and hyperglycemia.
  • Increased bone resorption is independently associated with female gender and dyslipidemia.
  • HIV-infected patients with metabolic abnormalities may benefit from bone density screening.

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