Deficits in bone strength, density and microarchitecture in women living with HIV:​ a cross-sectional HR-pQCT study

Macdonald, Heather M.; Maan, Evelyn J.; Berger, Claudie; Dunn, Rachel A.; Côté, Hélène C. F.; Murray, Melanie C. M.; Pick, Neora; Prior, Jerilynn C.

Affiliations

¹Department of Family Practice, Faculty of Medicine, University of British Columbia, 5950 University Blvd, Vancouver, British Columbia V6T 1Z3, Canada

²Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, 2735 Laurel St, Vancouver, British Columbia V5Z 1M9, Canada

³Oak Tree Clinic, BC Women's Hospital and Health Centre, 4500 Oak St, Vancouver, British Columbia V5Z 0A7, Canada

⁴Women's Health Research Institute, H214-4500 Oak St, Vancouver, British Columbia V6H 3N1, Canada

⁵Research Institute of the McGill University Health Centre, 2155 Guy Street, Suite 500, Montreal, Quebec H3H 2R9, Canada

⁶Department of Pathology & Laboratory Medicine, University of British Columbia, Rm. G227 – 2211 Wesbrook Mall, Vancouver, British Columbia V6T 2B5, Canada

⁷Centre for Blood Research, University of British Columbia, 4302-2350 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada

⁸Department of Medicine, Division of Infectious Diseases, University of British Columbia, 328C, Heather Pavilion East, VGH, 2733 Heather Street, Vancouver, British Columbia V5Z 3J5, Canada

⁹Department of Medicine, Division of Endocrinology, University of British Columbia, Gordon and Leslie Diamond Centre, 2775 Laurel Street, 4th Floor, Vancouver, British Columbia V5Z 1M9, Canada

¹⁰Centre for Menstrual Cycle and Ovulation Research, The Gordon and Leslie Diamond Health Care Centre, Room 4111 - 4th Floor, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada

Abstract and keywords

Purpose: With the advent of combined antiretroviral therapy (cART), life expectancy has increased among persons living with HIV, but so too has risk for comorbidities including osteoporosis and fragility fracture. To explore whether HIV status and cART influence three-dimensional measures of BMD, bone microarchitecture and strength we aimed to compare these outcomes between women living with HIV (WLWH; n = 50; 50.4 ± 1.2 years, 44% postmenopausal) and without HIV (controls; n = 50; 51.8 ± 1.2 years, 52% postmenopausal).

Methods: Outcomes were lumbar spine, total hip and femoral neck areal BMD by DXA; distal radius and tibia trabecular BMD, thickness and number, and cortical BMD and area by HR-pQCT; and finite element analysis-derived bone strength (failure load). Multivariable regression analysis compared bone outcomes between groups adjusting for known osteoporosis risk factors. Within WLWH, we examined associations between bone outcomes and HIV-related factors including disease severity and cART duration.

Results: WLWH were diagnosed 20 ± 4 years ago, were on cART for 123 ± 37 months and 80% had HIV plasma viral load <40 copies/mL. For women ≥50 years (n = 61), total hip aBMD T-Score was lower among WLWH than controls. Adjusted distal radius trabecular BMD and thickness and distal tibia trabecular BMD and failure load were 8–19% lower in WLWH than controls (p < 0.05). Cortical BMD and area did not differ between groups at either site. Lifetime cART duration and current plasma viral load were not associated with bone outcomes in WLWH; however, previous treatment with tenofovir was negatively associated with distal radius trabecular BMD and trabecular number and LS aBMD T-score.

Conclusions: WLWH have compromised BMD, bone microarchitecture and strength vs. controls of similar age and reproductive status. Treatment with tenofovir may contribute to bone deficits in WLWH.

Keywords: Human immunodeficiency virus; Bone strength; HR-pQCT; Women; Areal bone mineral density

Links

DOI: 10.1016/j.bone.2020.115509

PubMed: 32599222

WoS: 000557876000037

History

Received: 2020-02-4

Revised: 2020-06-16

Accepted: 2020-06-16

Online: 2020-06-27

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Cited By (2)

Year	Entry
2022	Olali AZ, Shi Q, Hoover DR, Bucovsky M, Shane E, Yin MT, Ross RD. Bone and fat hormonal crosstalk with antiretroviral initiation. Bone. January 2022;154:116208.
2022	Ó Breasail M, Gregson CL, Norris SA, Madanhire T, Jaff N, Crowther NJ, Micklesfield LK, Ward KA. Menopause is associated with bone loss, particularly at the distal radius, in black South African women: findings from the Study of Women Entering and in Endocrine Transition (SWEET). Bone. November 2022;164:116543.