Trabecular bone score (TBS) is associated with sub-clinical vertebral fractures in HIV-infected patients (original) (raw)
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Trabecular bone scores in young HIV-infected men: a matched case-control study
BMC Musculoskeletal Disorders
Background Screening for osteoporosis with dual-energy X-ray absorptiometry (DXA) is recommended for male HIV-infected patients only above the age of 50. Recently, trabecular bone score (TBS) has been introduced as a novel tool to assess bone microarchitecture using DXA of the lumbar spine. Few studies have reported TBS values in HIV-infected individuals younger than 50 years of age. This study compared TBS values in young males infected with HIV and matched controls, and investigated the associations between TBS and demographic parameters, clinical parameters, and bone mineral density (BMD) scores. Methods A cross-sectional study of BMD and TBS in HIV-infected men (n = 80) aged between 18 and 50 years and age- and sex-matched controls (n = 80) was conducted. Results The proportion of patients with low BMD (Z-score ≤ − 2) was significantly greater among HIV-infected patients than among matched controls (21.3% [17/80] vs. 8.8% [7/80], p = 0.027). Mean TBS values were significantly lo...
High prevalence of radiological vertebral fractures in HIV-infected males
Endocrine, 2012
Age-related co-morbidities including osteoporosis are relevant in patients responding to combination antiretroviral therapy (cART). Vertebral fractures are common osteoporotic fractures and their diagnosis is useful for managing at-risk individuals. However, there are few data from HIV-infected patients. Therefore, the aim of this study was to determine the prevalence of and factors associated with vertebral fractures in a population of HIV-infected males. A cross-sectional study of 160 HIV-infected patients with available chest X-rays was conducted from 1998 to 2010. One hundred and sixty-three males with comparable age and with no history of HIV infection were recruited as controls. Semi-quantitative evaluation of vertebral heights in lateral chest X-rays and quantitative morphometry assessment of centrally digitized images using dedicated morphometry software were utilized to detect prevalent vertebral fractures. The result showed that the vertebral fractures were detected in 43/160 (26.9%) HIV-infected patients and in 21/163 (12.9%) controls (P = 0.002). In HIV-infected patients with fractures, 27 had two or more fractures and ten patients had severe fractures. The prevalence of any fractures and multiple fractures in HIV-infected patients receiving cART (29.6 and 20.0%) was slightly higher than in HIV-infected patients not exposed to cART (17.1 and 5.7%), but significantly higher than control subjects (12.9 and 3.7%). At multivariable analyses, body mass index and diabetes mellitus were independently correlated with vertebral fractures in HIV-infected patients. We concluded that a significant proportion of HIV-infected males receiving cART showed vertebral fractures. Furthermore, proactive diagnosis of vertebral fragility fractures is particularly relevant in patients who are overweight or suffer from diabetes.
Relationship between Presarcopenia and Trabecular Bone Score in HIV - Infected People
International Journal of HIV/AIDS and Research, 2016
Objective: Antiretroviral therapy (ART) has transformed HIV-infection to a chronic disease. Nonetheless, since ART does not fully restore immune health, patients develop inflammation-associated complications considered the cornerstone in HIV-infection management. Osteoporosis is an important cause of morbidity in HIV-infected population and presarcopenia has emerged as important risk factor for osteoporosis. Trabecular bone score (TBS) is a novel method to evaluate bone microarchitecture. Our goal was to determine relationship between presarcopenia, osteoporosis and TBS in HIV-infected people. Methods: We designed a case-control study including 32 HIV-outpatients satisfying eligibility and exclusion criteria and 16 healthy-controls from local "TBS healthy-cohort". Densitometry studies were using a dual-energy X-ray absorptiometry (DXA). TBS was evaluated at DXA lumbar spine image using TBSiNsight ® v2.1. Skeletal muscle mass index (SMI) was defined as (appendicular skeletal muscle mass)/height2 (kg/m 2). Presarcopenia was established as SMI <7.26 kg/m 2 for men and SMI <5.55 kg/m 2 for women. Results: Presarcopenia prevalence was 31% and osteoporosis 12.5% in cases. HIV-cases have more prevalence of low TBS (44% vs 12.5%, p=0.031). Regarding HIV-infected group, poor correlation was found between TBS and presarcopenia (r:-0.174, p=0.342). Nevertheless, strong correlation was observed between TBS and lumbar spine bone mineral density (BMD) (r:0.590, p=0.001), and good correlations between TBS and femoral neck BMD (r:0.395, p=0.025) and TBS and total hip (r:0.365, p=0.040). Conclusions: This is the first study that evaluates presarcopenia and TBS relationship in HIV-positive people and strong correlations between TBS and BMD were found in our population. Even so, further researches are needed to analyze this association.
Frontiers in Endocrinology
The purpose of our study was to evaluate the alterations of bone metabolism and the prevalence of vertebral fractures in the population with HIV and hepatitis B and C seropositivity in treatment with antiretroviral drugs (HAART). Methods: We selected 83 patients with diagnosis of HIV, HBV, HCV infection. In all these patients biochemical examinations of phospho-calcium metabolism and a densitometry of lumbar spine were performed. We also evaluated lateral spine X-rays in order to analyze the presence of vertebral deformities and to define their severity. As a control group we analyzed the prevalence of vertebral fractures in a group of 40 non-infectious patients. Results: We selected 82 seropositive patients, 46 males and 37 females, with a median age of 55 ± 10 years. Out of these patients, 55 were infected by HIV, 12 were infected by HBV, 11 presented HIV and HCV co-infection and 4 were HCV+. The prevalence of hypovitaminosis D in the studied population was 53%, while the prevalence of osteoporosis and osteopenia was 14 and 48%, respectively. The average T-score in the fractured population was −1.9 SD. The viral load and the CD4+ cell count were respectively, directly, and inversely correlated with the number and severity of vertebral fractures. Antiretroviral therapy regimen containing TDF and PI was a significant determinant of the presence of vertebral deformities. The use of these drugs was also associated with lower levels of vitamin D and higher bone turnover levels compared to other antiretroviral drugs. Conclusions: HIV patients suffer from bone fragility, particularly at spine, independently by the level of bone mineral density. In this population, the T-score threshold for the risk of fracture is higher than that usually used in general population. For this reason, it would be indicated to perform an X-ray of the spine in order to detect vertebral deformities even in patients with a normal or slighlty reduced bone mineral density.
Low bone mineral density and risk of incident fracture in HIV-infected adults
Antiviral Therapy, 2015
Background: Prevalence rates of low bone mineral density (BMD) and bone fractures are higher among HIV-infected adults compared with the general United States (US) population, but the relationship between BMD and incident fractures in HIV-infected persons has not been well described. Methods: Dual energy X-ray absorptiometry (DXA) results of the femoral neck of the hip and clinical data were obtained prospectively during 2004-2012 from participants in two HIV cohort studies. Low BMD was defined by a T-score in the interval >-2.5 to <-1.0 (osteopenia) or ≤-2.5 (osteoporosis). We analysed the association of low BMD with risk of subsequent incident fractures, adjusted for sociodemographics, other risk factors and covariables, using multivariable proportional hazards regression. Results: Among 1,006 participants analysed (median age 43 years [IQR 36-49], 83% male, 67% non-Hispanic white, median CD4 + T-cell count 461 cells/mm 3 [IQR 311-658]), 36% (n=358) had osteopenia and 4% (n=37) osteoporosis; 67 had a prior fracture documented. During 4,068 personyears of observation after DXA scanning, 85 incident fractures occurred, predominantly rib/sternum (n=18), hand (n=14), foot (n=13) and wrist (n=11). In multivariable analyses, osteoporosis (adjusted hazard ratio [aHR] 4.02, 95% CI 2.02, 8.01) and current/prior tobacco use (aHR 1.59, 95% CI 1.02, 2.50) were associated with incident fracture. Conclusions: In this large sample of HIV-infected adults in the US, low baseline BMD was significantly associated with elevated risk of incident fracture. There is potential value of DXA screening in this population. Recent research and clinical experience in developed countries have brought an increasing appreciation of risks of bone disease among persons living with HIV infection. Studies in the United States (US) have shown high prevalence of low bone mineral density (BMD) among persons living with HIV [1-3]. Low BMD has been studied in various populations of antiretroviral therapy (ART)-naive and ART-experienced HIV-infected persons [3-6] and has been attributed to metabolic changes associated with HIV infection and use of some antiretrovirals, such as combination ART (cART) containing tenofovir [4,6,7]. Additionally, systemic inflammation/chronic immune activation has been associated with development of osteopenia and osteoporosis among HIV-infected persons [8,9]. Elevated bone fracture rates have been reported in multiple HIV cohorts [4,7,10-12]. We previously reported an increased risk of incident fractures among HIV Outpatient Study (HOPS) participants compared with the general population [12]. In this study, an increased fracture risk was associated with increasing age, lower nadir CD4 + T-cell count (CD4), HCV infection, diabetes and substance use.
HIV Research & Clinical Practice, 2020
Background: Among HIV-infected individuals, screening for bone disease is encouraged to assess reversible risk factors and plan therapeutic interventions. Objective: We assessed the usefulness of Fracture Risk Assessment (FRAX) tool to identify candidates for dual X-ray absorptiometry (DXA) scan, or individuals with bone loss progression. We further explored how secondary causes of osteoporosis are reflected on FRAX. Methods: Longitudinal study of 217 consecutive individuals (mean, 45.8 years, 24% females) included after DXA scan. FRAX was calculated without/with femoral neck bone mineral density (BMD), checking the box of "secondary osteoporosis" for all the individuals. Results: Low BMD was observed in 133/217 (61%) individuals, of whom 98.5% had not been selected as candidates for DXA by current FRAX thresholds. Specifically, 23% of individuals aged <50 had low BMD but none was candidate for DXA. Adding BMD data, FRAX results increased by 50-100%, with 2/217 individuals (1%) above the thresholds. Classical and HIV-related secondary causes of osteoporosis (observed in 98% overall) correlated with low BMD, modifying significantly FRAX results (HCV coinfection, +124%; longer time of HIV infection, +93%; longer time on antiretroviral therapy, +147%; tenofovir exposure +36%). Individuals with lower BMD and higher FRAX results at inclusion had less bone decline in a follow-up DXA after a median of 3.5 years. Conclusions: Currently recommended FRAX thresholds are not useful to select candidates for DXA scan, which could delay its performance in a population with a high prevalence of secondary factors for low BMD. Classical and HIV-related factors alter BMD and fracture risk estimation. Keywords: FRAX; bone disease; bone mineral density; dual-energy X-ray absorptiometry; fracture risk; secondary osteoporosis.
Bone Disease in HIV Infection: A Practical Review and Recommendations for HIV Care Providers
Clinical Infectious Diseases, 2010
Low bone mineral density (BMD) is prevalent in human immunodeficiency virus (HIV)-infected subjects. Initiation of antiretroviral therapy is associated with a 2%-6% decrease in BMD over the first 2 years, a decrease that is similar in magnitude to that sustained during the first 2 years of menopause. Recent studies have also described increased fracture rates in the HIV-infected population. The causes of low BMD in individuals with HIV infection appear to be multifactorial and likely represent a complex interaction between HIV infection, traditional osteoporosis risk factors, and antiretroviralrelated factors. In this review, we make the point that HIV infection should be considered as a risk factor for bone disease. We recommend screening patients with fragility fractures, all HIV-infected post-menopausal women, and all HIV-infected men у50 years of age. We also discuss the importance of considering secondary causes of osteoporosis. Finally, we discuss treatment of the more severe cases of bone disease, while outlining the caveats and gaps in our knowledge.