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Cortical and Trabecular Bone Deficit in Middle-Aged Men Living with HIV
Namki Hong1,2, Jung Ho Kim3, Graham Treece4
1Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
Insights
Middle-aged men with human immunodeficiency virus (MLWH) exhibit significantly lower hip bone density and bone deficit compared to controls. Lower CD4 counts and protease inhibitor regimens are linked to reduced bone density in MLWH.
Area of Science:
- Bone Metabolism and HIV Research
- Medical Imaging and Diagnostics
Background:
- Middle-aged men living with HIV (MLWH) face an elevated risk of hip fracture, occurring nearly a decade earlier than in uninfected individuals.
- Limited data exists on specific hip bone deficits (cortical and trabecular) in MLWH, crucial for understanding bone strength.
- Human immunodeficiency virus (HIV) infection and its treatments can impact bone health.
Purpose of the Study:
- To compare hip bone density and structural parameters between MLWH and healthy controls.
- To investigate the association between antiretroviral therapy (ART) regimens, CD4 counts, and bone health in MLWH.
- To identify specific regions of cortical and trabecular bone deficit in MLWH.
Main Methods:
- Quantitative CT scans were performed on 83 MLWH and 166 age- and BMI-matched controls.
- Hip volumetric bone mineral density (vBMD) and cortical bone mapping parameters (cortical thickness [CTh], cortical bone vBMD [CBMD], cortical mass surface density [CMSD], endocortical trabecular density [ECTD]) were analyzed.
- Statistical analyses adjusted for covariates including age, BMI, smoking, alcohol use, HCV co-infection, tenofovir exposure, and CT scanner types.
Main Results:
- MLWH demonstrated significantly lower total hip vBMD, CMSD, and ECTD compared to controls, even after covariate adjustment.
- Cortical bone mapping revealed localized deficits in CTh, CBMD, and CMSD in the anterolateral trochanteric region and femoral neck of MLWH.
- Lower CD4 T-cell counts and protease inhibitor (PI)-based ART regimens at ART initiation were independently associated with lower total hip vBMD and CMSD in MLWH.
Conclusions:
- MLWH exhibit reduced hip bone density characterized by cortical and trabecular bone deficits compared to community-dwelling controls.
- Specific regions of the hip, including the femoral neck, show localized bone structural abnormalities in MLWH.
- Lower CD4 T-cell counts and PI-based ART regimens are significant factors associated with poorer bone density in MLWH, highlighting potential targets for intervention.
Abstract:
A significant increase in the risk of hip fracture was observed in middle-aged men living with human immunodeficiency virus (MLWH), almost a decade earlier than those without infection. Data regarding cortical and trabecular bone deficit of hip, an important determinant of bone strength, in MLWH are limited. Quantitative CT was performed in consecutive MLWH aged ≥30 years between November 2017 and October 2018 at Severance Hospital, Seoul, Korea. Volumetric bone mineral density (vBMD) and cortical bone mapping parameters of hip (cortical thickness [CTh], cortical bone vBMD [CBMD], cortical mass surface density [CMSD], endocortical trabecular density [ECTD]) were compared to age-matched and body mass index (BMI)-matched controls (1:2) using a community-based healthy adults cohort. Among 83 MLWH and 166 controls (mean age: 47.2 years; BMI: 23.6 kg/m2 ), MLWH had lower total hip vBMD (280 ± 41 versus 296 ± 41 mg/cm3 ), CMSD (155 versus 160 mg/cm2 ), and ECTD (158 versus 175 mg/cm3 ) than controls that remained robust after adjustment for covariates (adjusted β: total hip vBMD, -18.8; CMSD, -7.3; ECTD, -18.0; p < 0.05 for all). Cortical bone mapping revealed localized deficit of CTh, CBMD, and CMSD in the anterolateral trochanteric region and femoral neck in MLWH compared to controls, with a more extensive ECTD deficit. In MLWH, lower CD4 T-cell count (/100 cells/mm3 decrement) and protease inhibitor (PI)-based regimen (versus non-PI regimen) at the time of antiretroviral treatment initiation were associated with lower total hip vBMD (adjusted β -7.5 for lower CD4 count; -28.3 for PI-based regimen) and CMSD (adjusted β -2.6 for lower CD4 count; -12.7 for PI-based regimen; p < 0.05 for all) after adjustment for covariates including age, BMI, smoking, alcohol use, hepatitis C virus co-infection, tenofovir exposure, and CT scanner types. MLWH had lower hip bone density with cortical and trabecular bone deficit compared to community-dwelling controls. © 2023 American Society for Bone and Mineral Research (ASBMR).
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