Increased Risk for Osteopenia, Osteoporosis in HIV Highlights Need for BMD Monitoring

As prevalence of osteoporosis and bone fracture risk are higher in individuals with HIV, bone mineral density (BMD) should be monitored on a regular basis, especially among women, according to new research published in the Journal of Antimicrobial Chemotherapy.

Although the risk of osteoporosis is higher among HIV-infected individuals compared with the general population, bone fractures remain relatively uncommon and physicians may be less likely to evaluate bone health in these patients. In this study, in an attempt identify what may occur as a result of this oversight, the authors assessed BMD to estimate risk of progression to osteopenia/osteoporosis in individuals with HIV.

The cohort included 875 patients who underwent at least 2 dual-energy x-ray absorptiometry (DXA) scans (3726 DXA scans total).  During 18 years of follow-up, the median number of scans per patient was 3 (range 2-18). Deterioration in BMD was observed in 174 (8%) men (94 from normal BMD to osteopenia and 80 from osteopenia to osteoporosis) and in 75 (11%) women (46 from normal BMD to osteopenia and 29 from osteopenia to osteoporosis).

The 10-year probability of transitioning from osteopenia to osteoporosis at ages 30 and 50 was 14.9% (95% CI, 10.5%-20.4%) and 19% (95% CI, 14.3%-24.3%) for men and 6.9% (95% CI 3.1%–14.4%) and 30.1% (95% CI 19.8%–41.8%) for women, respectively.

The risk of low BMD also varied according to the type of antiretroviral therapy the patient was receiving; treatment with darunavir and atazanavir was associated with a higher risk of progression to bone loss.

“Our results highlight the need for monitoring of bone mineral density owing to the high probability of progression to osteopenia, even at early ages,” write the authors.

Reference

Negredo E, Langohr K, Bonjoch A, et al. High risk and probability of progression to osteoporosis at 10 years in HIV-infected individuals: the role of PIs [published online June 1, 2018]. J Antimicrob Chemother. doi: 10.1093/jac/dky201