Can Bone Ultrasonography Accurately Detect HIV-induced Osteoporosis?

Researchers assessed whether bone ultrasonography parameters were altered with a tenofovir treatment regimen compared to other antiretroviral drugs.

Patients with HIV who are taking tenofovir showed lower bone ultrasonography (QUS) parameters than patients treated with other antiretroviral drugs, according to research presented at 26th American Association of Clinical Endocrinologists (AACE) Annual Scientific Sessions & Clinical Congress, May 3-7, in Austin, Texas.

Researchers at the University Hospital Santa Maria della Misericordia in Udine, Italy, collected data from 234 patients with HIV (147 men; 87 women). Of the 234 patients, 72% (n=167) were being treated with tenofovir. Mean age was 47±12 years. There was no difference in treatment regimens among men and women (both menopausal and fertile).

The primary end point was to assess whether QUS parameters were altered with a tenofovir treatment regimen. The secondary end point was to evaluate bone metabolism parameters.

Compared with patients receiving other antiretroviral drugs, patients treated with tenofovir showed lower speed of sound, lower broadband ultrasound attenuation, lower stiffness index, and lower T-score.

  • Speed of sound: 1554±40 m/sec vs 1569±51 m/sec; P =.018
  • Broadband ultrasound attenuation: 107.1±12.8 vs 112.0±13.9; P =.010
  • Stiffness index: 86.6±16.9 vs 93.9±21.5; P =.007
  • T-score: −1.01±1.32 vs −0.46±1.67; P =.008

Patients treated with tenofovir also showed higher parathyroid hormone and bone alkaline phosphatase.

  • Parathyroid hormone: 58.5±31.3 pg/mL vs 48.6±24.9 pg/mL; P =.024
  • Bone alkaline phosphatase: 22.5±11.9 vs 18.8±12.7 IU/L; P =.045

There was no difference between patients treated with tenofovir and patients treated with other antiretroviral drugs in terms of age, body mass index, duration of HIV infection, and antiretroviral therapy.

QUS is able to detect tenofovir-induced bone loss in patients with HIV. “Since [parathyroid hormone and bone alkaline phosphatase] are elevated in osteomalacia we can hypothesize that [tenofovir]-induced bone loss is mainly due to low bone mineralization rather than to osteoporosis,” the researchers wrote. “In contrast to this hypothesis, however, we did not find any difference in blood phosphate between the 2 groups.”

Ultimately, the researchers concluded more study is required to validate QUS in HIV-positive patients.

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Grimaldi F, Vescini F, Londero A, et al. Effects of tenofovir on bone ultrasound parameters and bone metabolism in HIV-positive patients. Presented at: 26th American Association of Clinical Endocrinologists Annual Scientific Sessions & Clinical Congress. May 3-7, 2017; Austin, TX. Abstract 533.

This article originally appeared on Endocrinology Advisor