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Bone Accrual Trajectories in Children and Adolescents With Perinatal HIV Infection
Linda Anne DiMeglio1, Wendy Yu2, Heidi J Kalkwarf3
1Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
Insights
Children with perinatally acquired HIV (PHIV) show persistent bone density deficits throughout puberty compared to healthy peers. Spine bone mineral density and content Z-scores were exceptions, indicating varied bone accrual patterns in PHIV.
Area of Science:
- Pediatric endocrinology
- Bone health in HIV
- Growth and development
Background:
- Children and adolescents with perinatally acquired HIV (PHIV) often exhibit low bone mineral density (BMD).
- Limited data exist on bone accrual patterns during puberty in PHIV compared to healthy children.
Purpose of the Study:
- To compare bone accrual in children with PHIV versus a healthy cohort throughout puberty.
Main Methods:
- Dual-energy X-ray absorptiometry (DXA) was used to assess bone mineral density (BMD) and bone mineral content (BMC) in 172 PHIV children and 1321 healthy children from the Bone Mineral Density in Childhood Study (BMDCS).
- Height-adjusted whole-body and spine BMD and BMC Z-scores were calculated and compared across age using mixed-effects models.
Main Results:
- PHIV children had lower height-adjusted whole-body BMD and BMC Z-scores compared to the BMDCS cohort.
- Spine BMD Z-scores were higher in PHIV children after height adjustment.
- Bone area accrual was slower in PHIV children before age 14, with similar accrual rates after age 15.
Conclusions:
- PHIV children demonstrated persistent deficits in most bone measures, with height-adjusted spine BMD and BMC Z-scores being notable exceptions.
- Further longitudinal data are required to understand bone health in PHIV individuals into adulthood.
Context:
Low bone mineral density (BMD) has been reported in children and adolescents living with perinatally acquired HIV (PHIV). Little is known about their bone accrual through puberty compared to an uninfected healthy cohort.
Objective:
To compare bone accrual in PHIV and healthy children.
Design:
PHIV children aged 7 to 16 years had dual-energy X-ray absorptiometry at entry, at 2 years, and then at least 2 years later. Bone accrual was compared to healthy children from the Bone Mineral Density in Childhood Study (BMDCS).
Setting:
US academic clinical research centers.
Patients:
172 PHIV; 1321 BMDCS.
Analysis:
We calculated height-adjusted whole-body and spine BMD and bone mineral content (BMC) Z-scores in PHIV using BMDCS reference curves. We fit piecewise weighted linear mixed effects models with change points at 11 and 15 years, adjusted for age, sex, race, height Z-score, and Tanner stage, to compare BMD and BMC Z-scores across actual age by cohort.
Main Outcome Measure:
BMD/BMC Z-scores.
Results:
Height-adjusted whole-body BMD and BMC Z-scores in PHIV were lower across age compared to BMDCS children. Spine BMD Z-score across age was higher in PHIV after height adjustment. Whole-body and spine bone area tended to be lower in PHIV children. PHIV children had slower accrual in whole-body and spine bone area before 14 years. After 15 years, bone area accruals were similar, as were height-adjusted spine BMC Z-scores, across age.
Conclusion:
PHIV children had persistent deficits in all measures except height-adjusted spine BMD and BMC Z-scores. Data are needed on PHIV children followed to adulthood.
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