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Impact of Alcohol on Bone Health in People Living With HIV: Integrating Clinical Data From Serum Bone Markers With
Alexandra Denys1, Allison Norman1, Daniel S Perrien2
1Department of Pharmacology and Experimental Therapeutics Louisiana State University Health Sciences Center New Orleans LA USA.
Insights
Alcohol use negatively impacts bone health in people living with HIV (PLWH), especially older individuals. Sclerostin may play a role in alcohol-induced bone loss in this vulnerable population.
Area of Science:
- Musculoskeletal health
- Endocrinology
- Infectious disease research
Background:
- People living with HIV (PLWH) are susceptible to bone loss due to HIV, antiretroviral therapy (ART), and alcohol use.
- Understanding alcohol's impact on bone health in PLWH is crucial for developing preventive strategies.
Purpose of the Study:
- To investigate the association between alcohol consumption and bone health markers in PLWH.
- To explore the effects of alcohol and estrogen status on bone in a translational macaque model.
Main Methods:
- Analysis of serum biochemical markers of bone turnover (osteocalcin, PINP, sclerostin) in a diverse cohort of PLWH.
- A translational study using SIV-infected/ART-treated rhesus macaques with and without ovariectomy and alcohol exposure.
- Micro-CT analysis of macaque tibias to assess bone microarchitecture.
Main Results:
- Alcohol consumption was inversely associated with bone formation markers (osteocalcin, PINP) in PLWH.
- Older age and postmenopausal status increased susceptibility to alcohol-induced bone loss.
- Sclerostin levels correlated positively with alcohol use and negatively with osteocalcin.
- Alcohol and ovariectomy independently reduced trabecular number and bone mineral density in macaques.
Conclusions:
- Alcohol consumption contributes to reduced bone formation and potentially osteopenia in PLWH.
- Circulating sclerostin may be implicated in the pathogenesis of alcohol-induced bone loss.
- Further research using advanced skeletal imaging is needed to fully understand alcohol's impact on bone microarchitecture in PLWH.
Abstract:
People living with HIV (PLWH) represent a vulnerable population to adverse musculoskeletal outcomes due to HIV infection, antiretroviral therapy (ART), and at-risk alcohol use. Developing measures to prevent skeletal degeneration in this group requires a grasp of the relationship between alcohol use and low bone mass in both the PLWH population and its constituents as defined by sex, age, and race. We examined the association of alcohol use with serum biochemical markers of bone health in a diverse cohort of PLWH enrolled in the New Orleans Alcohol Use in HIV (NOAH) study. To explore the effects of alcohol on bone in the context of HIV and ART and the role of estrogen, we conducted a parallel, translational study using simian immunodeficiency virus (SIV)+/ART+ female rhesus macaques divided into four groups: vehicle (Veh)/Sham; chronic binge alcohol (CBA)/Sham; Veh/ovariectomy (OVX); and CBA/OVX. Clinical data showed that both osteocalcin (Ocn) and procollagen type I N-propeptide (PINP) levels were inversely associated with multiple measures of alcohol consumption. Age (>50 years) significantly increased susceptibility to alcohol-associated suppression of bone formation in both female and male PLWH, with postmenopausal status appearing as an additional risk factor in females. Serum sclerostin (Scl) levels correlated positively with measures of alcohol use and negatively with Ocn. Micro-CT analysis of the macaque tibias revealed that although both CBA and OVX independently decreased trabecular number and bone mineral density, only OVX decreased trabecular bone volume fraction and impacted cortical geometry. The clinical data implicate circulating Scl in the pathogenesis of alcohol-induced osteopenia and suggest that bone morphology can be significantly altered in the absence of net change in osteoblast function as measured by serum markers. Inclusion of sophisticated tools to evaluate skeletal strength in clinical populations will be essential to understand the impact of alcohol-induced changes in bone microarchitecture. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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