Impact of hypogonadism on bone mineral density and vertebral fractures in HIV-infected men

L. C. Pezzaioli,F. Castelli,T. Porcelli,A. Delbarba,A. Ferlin,M. E. Quiros-Roldan,F. Maffezzoni,E. Focà,C. Cappelli

doi:10.1007/s40618-021-01665-7

Abstract

PurposeHypogonadism and osteoporosis are frequently reported in HIV-infected men and, besides multifactorial pathogenesis, they might be directly linked because of testicular involvement in bone health. We evaluated the prevalence of osteoporosis and vertebral fractures (VFs) in HIV-infected men, and assessed their relationship with gonadal function.MethodsWe enrolled 168 HIV-infected men (median age 53). Osteoporosis and osteopenia were defined with T-score ≤ – 2.5SD and T-score between – 1 and – 2.5SD, respectively. VFs were assessed by quantitative morphometric analysis. Total testosterone (TT), calculated free testosterone (cFT), Sex Hormone Binding Globulin (SHBG), Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH) were obtained; overt hypogonadism was defined on symptoms and low TT or cFT, and classified into primary and secondary according to gonadotropins; compensated hypogonadism was defined as normal TT and cFT with high LH levels.ResultsOverall, osteoporosis and osteopenia were found in 87.5% of patients, and VFs were detected in 25% of them; hypogonadism was identified in 26.2% of cases. Osteoporotic patients had higher SHBG vs those with normal bone mineral density (BMD). Fractured patients were more frequently hypogonadal and with higher SHBG. SHBG showed negative correlation with both spine and femoral BMD, and positive correlation with VFs. In multivariate models, FSH showed negative impact only on femoral BMD, whereas older age and higher SHBG predicted VFs.ConclusionWe found a high burden of bone disease and hypogonadism in HIV-infected men, and we showed that the impact of gonadal function on bone health is more evident on VFs than on BMD.

Highlights

The introduction of combined antiretroviral therapy has radically changed the course of HIV infection with an increase in life expectancy, and has led to an increased prevalence of aging-related diseases, such as hypogonadism and osteoporosis [1]
We found a high burden of bone disease in HIV-infected men under chronic combined antiretroviral therapy (cART), being over two thirds of them osteopenic/osteoporotic, and presenting with at least one vertebral fractures (VFs) in 25% of cases
We found that the impact of gonadal function on bone health is more evident on VFs than on bone mineral density (BMD)

Summary

Introduction

The introduction of combined antiretroviral therapy (cART) has radically changed the course of HIV infection with an increase in life expectancy, and has led to an increased prevalence of aging-related diseases, such as hypogonadism and osteoporosis [1]. The diagnosis of hypogonadism relies on the combination of low morning testosterone levels and clinical manifestations. Journal of Endocrinological Investigation of androgen deficiency [4, 5], including sexual symptoms (reduced libido, erectile dysfunction, decreased spontaneous erections) and less specific signs and symptoms (loss of body/facial hair, decreased testicular volume, increased body fat/reduced muscle mass, central obesity, osteoporosis, asthenia, decreased concentration, etc.) [4]. The diagnosis of hypogonadism in men with HIV can be challenging, as they often present with non-specific symptoms or with signs/symptoms overlapping with other comorbidities (e.g., obesity, HCV, diabetes) [1]. Sexual symptoms in men with HIV might have multiple causes other than hypogonadism [1]

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Conclusion