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Published on: January 29, 2018
Unravelling hip-spine bone mineral density discordance in people living with HIV
Pilar Vizcarra1, Marta Rosillo2, José M Del Rey2
1Department of Infectious Diseases, Hospital, Universitario Ramón y Cajal, Cra. Colmenar Km 9.1, 28034, Madrid, Spain. pilar1vizcarra@gmail.com.
Insights
Hip-spine bone mineral density (BMD) discordance is common in people living with HIV (PLWH), affecting osteoporosis diagnosis and increasing fracture risk. This highlights the need for careful assessment in this population.
Area of Science:
- Endocrinology
- Infectious Diseases
- Osteoporosis Research
Background:
- People living with HIV (PLWH) have a high risk of secondary osteoporosis.
- Bone mineral density (BMD) discordance between the lumbar spine (LS) and femoral neck (FN) may be prevalent in PLWH due to HIV-related bone disease factors.
Purpose of the Study:
- To investigate the prevalence and characteristics of hip-spine BMD discordance in PLWH.
- To identify factors associated with this discordance and its impact on osteoporosis diagnosis and fracture risk estimation.
Main Methods:
- Retrospective cohort study of 865 PLWH who underwent dual X-ray absorptiometry scans.
- Hip-spine BMD discordance defined by differing T-score or Z-score categories at LS and FN.
- Multivariate regression analysis and FRAX equation used to assess associations and fracture risk.
Main Results:
- 44% of PLWH exhibited hip-spine BMD discordance, increasing with age.
- Discordance was mainly due to lower LS-BMD; lower FN-BMD linked to older age, lower BMI, and HIV factors (low CD4+ T-cell counts, HIV duration, ART duration).
- Male sex, hyperparathyroidism, and time on ART were independently associated with discordance. Discordance with lower FN-BMD showed significantly higher estimated fracture risk.
Conclusions:
- Hip-spine BMD discordance is highly prevalent in PLWH.
- This discordance is associated with both traditional and HIV-specific risk factors.
- The findings suggest that hip-spine BMD discordance significantly modifies osteoporosis diagnosis rates and fracture risk assessment in PLWH.
Introduction:
In people living with HIV (PLWH), bone mineral density (BMD) discordance between the lumbar spine (LS) and femoral neck (FN) could be frequent given the high frequency of secondary osteoporosis, including HIV-related factors for bone disease.
Materials And Methods:
Retrospective cohort of PLWH with a dual X-ray absorptiometry scan. Hip-spine BMD discordance was defined as different T-score or Z-scores categories at LS and FN.
Results:
Overall, 865 individuals (mean 49.5 years, female 27%) were included. Osteoporosis diagnosis was four-to-seven times lower when both skeletal sites were affected than when considering the lowest T-score at any site (overall, 21% vs 4%). Hip-spine BMD discordance was observed in 381 (44%) individuals, it increased with age (from 43 to 52%, P = 0.032), and it was mainly due to lower LS-BMD. A lower FN-BMD was associated with older age, lower BMI (P < 0.01), and HIV-related factors, such as low CD4 + T-cell counts, duration of HIV infection, and time on antiretroviral therapy (ART). In a multivariate regression analysis, sex male (Odds Ratio, OR 4.901), hyperparathyroidism (OR, 2.364), and time on ART (OR 1.005 per month) were independently associated with discordance. A higher estimated fracture risk by FRAX equation was observed in individuals with BMD discordance due to lower FN-BMD compared to those with lower LS-BMD (+ 36% for major osteoporotic fracture, P = 0.04; + 135% for hip fracture, P < 0.01).
Conclusion:
Hip-spine BMD discordance is highly prevalent in PLWH and it is associated with classical and HIV-related risk factors, modifying the rate of osteoporosis and fracture risk estimation.
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