Abstract
With advances in combination antiretroviral therapy (cART), people living with HIV are now surviving to experience aging. Evidence suggests that individuals living with HIV are at greater risk for low bone mineral density (BMD), osteoporosis, and fractures. Better understanding of the pathophysiology of bone health in women living with HIV (WLWH) is important for treatment strategies. The goal of this study was to explore new biological factors linked to low BMD in WLWH. Standardized BMD measures of WLWH were compared to reference values from an unselected population of women from the same geographical region of the same age range. Linear regression analysis was used to assess relationships among health-related characteristics, cellular aging (measured by leukocyte telomere length; LTL), cART, and BMD of WLWH. WLWH (n = 73; mean age 43 ± 9 years) had lower BMD Z-scores at the lumbar spine (LS) (mean difference = −0.39, p < 0.001) and total hip (TH) (−0.29, p = 0.012) relative to controls (n = 290). WLWH between 50 and 60 years (n = 17) had lower Z-scores at the LS (p = 0.008) and TH (p = 0.027) compared to controls (n = 167). Among WLWH, LS BMD was significantly associated with LTL (R2 = 0.09, p = 0.009) and BMI (R2 = 0.06, p = 0.042). Spinal BMD was adversely affected in WLWH. Reduction of LTL was strongly associated with lower BMD and may relate to its pathophysiology and premature aging in WLWH.
Highlights
With the progress in HIV combination antiretroviral therapy and the aging of people living with HIV (PLWH), there is increasing evidence that living with HIV is a significant risk factor for low bone mineral density (BMD) and fragility fractures [1,2,3,4,5,6,7,8]
A previous case-control analysis of Canadian women living with HIV (WLWH) and age-matched controls derived from the national Canadian Multicentre Osteoporosis Study (CaMos) showed WLWH had an odds ratios (ORs) of 1.7 for having experienced a prevalent fragility fracture [6]
Our study was aimed at addressing some of the gender gaps by providing further data related to how lumbar spine (LS), total hip (TH), and femoral neck (FN) BMD of women living with HIV compare with the regional reference population, and what factors associated with their relatively poor bone health. It is a strength of this study that it compared local WLWH with a population-based regional CaMos control cohort and that, for the first time, we showed a relationship between the aging-related variable, leukocyte telomere length, and BMD in WLWH
Summary
With the progress in HIV combination antiretroviral therapy (cART) and the aging of people living with HIV (PLWH), there is increasing evidence that living with HIV is a significant risk factor for low bone mineral density (BMD) and fragility fractures [1,2,3,4,5,6,7,8]. A meta-analysis of 20 studies in PWLH compared to uninfected controls [9] showed the pooled odds ratios (ORs) for having osteopenia and osteoporosis were 6.4 and 3.7, respectively. A previous case-control analysis of Canadian women living with HIV (WLWH) (mean age of 38 years) and age-matched controls derived from the national Canadian Multicentre Osteoporosis Study (CaMos) showed WLWH had an OR of 1.7 for having experienced a prevalent fragility fracture (i.e., low trauma fracture, such as with a fall from standing height) [6]. A Spanish population-based study including both men and women reported that an HIV diagnosis increased the risk of a hip fracture by 5-fold, independent of sex, age, tobacco or alcohol use, and comorbidities [10]. Given that >50% of PLWH globally are women, with the majority being of reproductive age [14], a greater understanding of the pathophysiology of bone health in WLWH is needed to develop optimal preventative and treatment strategies as they age
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