ABSTRACT
Objective:
Human Immundeficiency virus (HIV) infection is a risk factor for low bone mineral density (BMD). International HIV/AIDS guidelines do not recommend BMD screening for every patient. In this study, we aimed to compare the risk factors for the development of osteoporosis/osteopenia between patients with treatment naive HIV infection, to whom routine BMD screening is not recommended and patients with osteoporosis/osteopenia risk factors like men over 50 years of age, postmenopausal women to whom routine BMD screening is recommended.
Materials and Methods:
A database was created in which the demographic, clinical and laboratory features of patients with HIV infection were recorded in the infectious diseases outpatient clinic between January 2015 and June 2019. A total of 284 HIV-infected patients with dual-energy X-ray absorptiometry (DXA) measurements at admission and before antiretroviral treatment were included in the study. The characteristics of those aged ≥50 years/postmenopausal and <50 years naive HIV-infected patients with osteoporosis/osteopenia were compared.
Results:
Overall, 131 (46%) of 284 treatment-naive HIV-infected individuals were diagnosed with osteoporosis/osteopenia by DXA. The osteoporosis/osteopenia rate was 42.9% (106/247) and 67% (25/37) in those aged <50 and ≥50 years, respectively (p= 0.007). Osteoporosis was detected in 26 patients and 16 (61.5%) were <50 years. Further, decrease in BMD was most commonly observed in the femoral region among the elderly and in the lumbar and femoral regions among the young individuals (p<0.001).
Conclusion:
This study reveals a high rate of decrease in BMD among our young patients who were not exposed to antiretroviral therapy. The early detection of the presence of osteoporosis/osteopenia is important to increase the quality of life and to decrease the drug load. Therefore, we recommend performing diagnostic tests at any age in naive patients for low BMD detection and early treatment, regardless of the treatment.
Keywords:
HIV, bone mineral density, osteoporosis, osteopenia
References
1Tigen ET, Korten V. HIV Enfeksiyonu ve Antiretroviral Tedavinin Osteopeni Gelişimine Etkileri. Klimik Dergisi 2012;25:51-7.
2Lima AL, de Oliveira PR, Plapler PG, Marcolino FM, de Souza Meirelles E, Sugawara A, et al. Osteopenia and osteoporosis in people living with HIV: multiprofessional approach. HIV AIDS (Auckl) 2011;3:117-24.
3Türkiye Endokrinoloji ve Metabolizma Derneği Osteoporoz ve Metabolik Kemik Hastalıkları Tanı ve Tedavi Kılavuzu. 2019, Ankara. Available from URL: http://temd.org.tr/admin/uploads/tbl_kilavuz/20190506164125-2019tbl_kilavuz0f7419cd64.pdf. Accessed February 01, 2020.
4Tuzun S, Eskiyurt N, Akarirmak U, Saridogan M, Senocak M, Johansson H, et al. Incidence of hip fractue and prevalance of osteoporosis in Turkey: the FRACTURK study. Osteoporos Int 2012;23:949-55.
5Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C. Excess mortality following hip fracture: a systematic epidemiological review. Osteoporosis International 2009;20:1633-50.
6EACS European AIDS Clinical Society. EACS Guidelines 10.0. November 2019. Available from:s URL:https://www.eacsociety.org/files/2019_guidelines-10.0_final.pdf. Accessed February, 01, 2020.
7Centers for Disease Control and Prevention. Diagnoses of HIV infection among adults aged 50 years and older in the United States and dependent areas, 2011-2016. HIV Surveillance Supplemental Report 2018;23 (No. 5). Available from:s URL: http://www.cdc.gov/hiv/library/reports/hiv- surveillance.html. Published August 2018. Accessed February 01, 2020. Available from:s URL: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-23-5.pdf.
8Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, et al. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int 2014;25:2359-81.
9Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser 1994;843:1-129. https://apps.who.int/iris/bitstream/handle/10665/39142/WHO_TRS_843_eng.pdf?sequence=1&isAllowed=y. Accessed: February, 01, 2020.
10Biver E, Calmy A, Aubry-Rozier B, Birkhäuser M, Bischoff-Ferrari HA, Ferrari S, et al. (2019). Diagnosis, prevention, and treatment of bone fragility in people living with HIV: a position statement from the Swiss Association against Osteoporosis. Osteoporosis Int 2019;30:1125-35.
11Powderly WG. Osteoporosis and bone health in HIV. Curr HIV/AIDS Rep 2012;9:218-22.
12Da Silva Chaba DC, Soares LR, Pereira RMR, Rutherford GW, Assone T, Takayama L, et al. Low bone mineral density among HIV-infected patients in Brazil. Rev Inst Med Trop Sao Paulo 2017;59:e89.
13Escota GV, Mondy K, Bush T, Conley L, Brooks JT, Onen N, et al. High prevalence of low bone mineral density and substantial bone loss over 4 years among hıv-infected persons in the era of modern antiretroviral therapy. AIDS Res Hum Retroviruses 2016;32:59-67.
14Gümüşer F, Arslan F. HIV Pozitif Erkek Hastalarda Osteopeni/Osteoporoz Durumu ve D Vitamini Düzeyleri. FLORA 2019;24:52-62.
15Aydın OA, Karaosmanoglu HK, Karahasanoglu R, Tahmaz M, Nazlıcan O. Prevalence and risk factors of osteopenia/osteoporosis in Turkish HIV/AIDS patients. Braz J Infect Dis 2013;17:707-11.
16Çimen C, Aksu-Sayman Ö, Fincancı M. Measurement of bone mineral density in HIV-infected individuals who are not considered as a specific risk group for bone mineral densitometry screening. Klimik Derg 2019;32:318-23.
17Brown TT, Chen Y, Currier JS, Ribaudo HJ, Rothenberg J, Dubé MP, et al. Body composition, soluble markers of inflammation, and bone mineral density in antiretroviral therapy-naive HIV-1-infected individuals. J Acquir Immune Defic Syndr 2013;63:323-30.
