Abstract
BackgroundAlgorithms for bone mineral density (BMD) management in HIV-infected patients are lacking. Our objective was to assess how often a dual-energy x-ray absorptiometry (DXA) scan should be performed by assessing time of progression to osteopenia/osteoporosis.MethodsAll DXA scans performed between 2000 and 2009 from HIV-infected patients with at least two DXA were included. Time to an event (osteopenia and osteoporosis) was assessed using the Kaplan–Meier method. Strata (tertiles) were defined using baseline minimum T scores. Differences between strata in time to an event were compared with the log-rank test.ResultsOf 391 patients (1,639 DXAs), 49.6% had osteopenia and 21.7% osteoporosis at their first DXA scan. Of the 112 (28.6%) with normal BMD, 35.7% progressed to osteopenia; median progression time was 6.7 years. These patients were stratified: “low-risk" (baseline minimum T score >−0.2 SD), “middle-risk" (between −0.2 and −0.6 SD), and “high-risk" (from −0.6 to −1 SD); median progression time to osteopenia was 8.7, >7.2, and 1.7 years, respectively (p<0.0001). Of patients with osteopenia, 23.7% progressed to osteoporosis; median progression time was >8.5 years. Progression time was >8.2 years in “low-risk" tertile (T score between −1.1 and −1.6 SD), >8.5 years in “middle-risk" (between −1.6 and −2), and 3.2 years in “high-risk" (from −2 to −2.4) (p<0.0001).ConclusionsOur results may help to define the BMD testing interval. The lowest T score tertiles would suggest recommending a subsequent DXA in 1–2 years; in the highest tertiles, ≥6 years. Early intervention in patients with bone demineralization could reduce fracture–related morbidity/mortality.
Highlights
Bone strength is the result of bone mineral density (BMD) and bone microarchitecture
Accelerated bone demineralization in this population is due to an additional number of factors such as the HIV infection itself and the chronic inflammatory status, by increasing apoptosis of osteoblast cells and promotion of osteoclastic activity [6,7,8,9,10,11,12,13,14,15], the exposure to specific antiretroviral agents [2,13,16,17,18] and the immune reconstitution [14,19,20], together with traditional risk factors, such as vitamin D insufficiency, a secondary cause of osteoporosis that is very prevalent among HIV-infected patients. [21]
This study aims to determine how often a dual-energy x-ray absorptiometry (DXA) scan should be performed in chronically HIV-infected patients by assessing the time of progression to osteopenia or osteoporosis in a large cohort
Summary
Bone strength is the result of bone mineral density (BMD) and bone microarchitecture. A decrease in BMD leads to deterioration of microarchitecture, and is determined by the intensity of bone remodeling. These changes lead to critical damage and porosity that weaken bone and increase the probability of fractures.[1]. The results of several studies confirm a higher incidence of osteopenia and osteoporosis in HIV-infected patients than in HIV-negative individuals. Algorithms for bone mineral density (BMD) management in HIV-infected patients are lacking. Our objective was to assess how often a dual-energy x-ray absorptiometry (DXA) scan should be performed by assessing time of progression to osteopenia/osteoporosis
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