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Brief Report: Aging Attenuates the Association Between Coronary Artery Calcification and Bone Loss Among HIV-Infected
Gerome Escota1, Jason Baker2, Tim Bush3
1Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, MO.
Insights
In HIV-infected individuals, detectable coronary artery calcium (CAC) was linked to lower bone mineral density (BMD). However, aging diminishes this association, highlighting the need for screening in aging HIV populations.
Area of Science:
- Cardiology
- Bone Metabolism
- HIV Medicine
Background:
- Coronary artery calcium (CAC) is linked to low bone mineral density (BMD) in older HIV-uninfected individuals.
- The relationship between CAC and BMD in younger to middle-aged HIV-infected persons is not well-described.
Purpose of the Study:
- To assess the association between CAC and BMD in a cohort of HIV-infected individuals.
- To investigate the influence of aging on the CAC-BMD relationship in this population.
Main Methods:
- Prospective cohort study of HIV-infected participants (Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy - SUN).
- Logistic regression analysis was used to evaluate the association between detectable CAC and BMD.
- Adjustments were made for traditional and HIV-related risk factors, including age.
Main Results:
- Among 472 participants (median age 41 years), 82% had no detectable CAC, while 53% had osteopenia and 10% had osteoporosis.
- Univariate analysis showed detectable CAC was associated with lower BMD and higher rates of osteopenia/osteoporosis.
- After adjusting for age, these associations were no longer significant.
Conclusions:
- Aging attenuates the association between detectable CAC and BMD in HIV-infected individuals.
- Aging is a significant factor in non-AIDS-defining illnesses among people with HIV.
- Screening and prevention strategies are crucial for aging HIV-infected individuals due to their elevated risk of end-organ complications.
Introduction:
Studies among HIV-uninfected persons (mostly in their sixth decade of life) show that detectable coronary artery calcium (CAC) is independently associated with low bone mineral density (BMD), suggesting a possible common pathogenic mechanism.
Aim:
We assessed the relationship between CAC and BMD, which has not been well described among younger to middle-aged HIV-infected persons.
Methods:
We studied participants with baseline CAC and BMD measures from a prospective cohort of HIV-infected persons enrolled in the Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy (SUN) during 2004-2006. We used logistic regression to assess the association between detectable CAC (>0 Agatston score) and BMD (g/cm, T-score), and adjusted for known traditional and HIV-related risk factors.
Results:
Among 472 participants (76% male, 30% non-Hispanic black, median age 41 years, and 71% with HIV RNA < 400 copies/mL), the majority had no detectable CAC (82%), but had baseline osteopenia (53%) or osteoporosis (10%). In univariate analysis, participants with detectable CAC had lower femoral neck/total hip T-scores, lower femoral neck/total hip/lumbar spine BMD, and higher rates of osteopenia/osteoporosis. After adjustment for age, all associations were no longer significant; adjustment for traditional risk factors excluding age and HIV-related variables failed to attenuate these associations.
Conclusions:
We found aging attenuates the association between detectable CAC and BMD in this cohort. Aging remains an important contributor to non-AIDS-defining illnesses. These data reinforce the importance of developing screening and prevention strategies for aging HIV-infected persons given their excess risk across a wide spectrum of end-organ complications.
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