Discordance in diagnosis of osteoporosis in HIV-infected patients: prevalence, characteristics and impact on FRAX equation
P Vizcarra1, J Gallego1, MJ Vivancos1, C Sobrino2, WA Sifuentes2, JL Casado1
1Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain; 2Department of Rheumatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
Objective: We examined the prevalence and characteristics of people living with HIV (PLHIV) with spine-hip bone mineral density (BMD) measurement discordance.
Methods: Cross-sectional study of consecutive PLHIV included after whole-body dual X-ray absorptiometry (DXA) scan. BMD categories of osteoporosis, osteopenia and normal bone mass were defined as T-scores ≤-2.5, −2.5 to 1.0 and >-1.0, respectively. Discordance was defined as different BMD categories at lumbar spine (LS) and femoral neck (FN): major discordance in the case of osteoporosis versus normal BMD, and minor discordance in the case of osteoporosis versus osteopenia, or osteopenia versus normal BMD.
Results: Of a total of 208 PLHIV (mean 46 years, women 23%), 91 (44%) presented BMD discordance (major discordance, 2%; minor discordance, 42%); similar values were observed in individuals aged under and over 50. Discordance due to lower LS-BMD was more frequent, and 81% (30/37) of individuals with LS osteoporosis had discordance. Conversely, of 10 cases of FN osteoporosis, 43% were missed from measurements at the LS. Individuals with BMD discordance had distinctive characteristics: PLHIV with lower FN-BMD had a significantly higher prevalence of smoking (P=0.01), lipodystrophy (P=0.03) and HCV coinfection (P=0.04), and longer duration of HIV infection (P=0.04) and antiretroviral therapy (P=0.01) than individuals with lower LS-BMD. Moreover, the risk of major osteoporotic and hip fracture was significantly higher in PLHIV with lower FN-BMD versus lower LS-BMD (+36%, P=0.04, and +135%, P<0.01, respectively; Figure 1).
Fracture risk in patients with discordance according to the site of lower bone mineral density (Abstract P17)
Conclusions: BMD measurement discordance was observed in 44% of PLHIV, largely due to lower LS-BMD. BMD measurement at a single site underestimates the prevalence of osteoporosis, as over 80% of cases of LS osteoporosis were not reflected by FN-BMD. HIV-related factors contribute to lower FN-BMD and in part, to discordance. Fracture risk estimation by FRAX was higher for PLHIV with discordant results.
Abstract P18
Antiviral Therapy 2019; 24 Suppl 1:A61
Menopause in ageing women living with HIV: changes in bone mineral density and trabecular bone score
D Morini1, A Malagoli2, J Milic2,3, F Carli2, A Raimondi2, I Franconi2, C Mussini2, V Rochira4, G Guaraldi2
1University of Modena and Reggio Emilia, Modena, Italy; 2Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Italy; 3Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy; 4Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
Objective: HIV infection and tenofovir disoproxil fumarate (TDF)-containing antiretroviral regimens alone or in association with boosted protease inhibitors are associated with impaired bone quality and quantity and high fracture risk. Bone loss has never been studied across the menopausal transition in women living with HIV (WLWH). The aim of the study was to describe pattern of bone quantity (lumbar bone mineral density [BMD]) and bone quality (trabecular bone score [TBS]) changes across menopause in WLWH undergoing ART with or without TDF.
Methods: We conducted a longitudinal retrospective study including WLWH attending Modena HIV Metabolic Clinic from 2012 to 2019. The observation period was divided into reproductive, transitional, early and late menopause according to STRAW criteria. Lumbar BMD and TBS derived from DEXA evaluation. GEE models were built to predict changes in BMD and TBS across menopause and TDF or TDF+PI/r/c containing ART regimens.
Results: We included 185 (mean age =49.3 years) ART-experienced women observed for a median of 6.08 years. 134 observations were assessed in the ‘Reproductive Period’, 180 in the ‘Menopause Transition Period’, 185 in the ‘Early Menopause Period’ and 20 in the ‘Late Menopause Period’, for a total of 519 DEXA observations. At baseline, median duration of HIV infection was 244 months, median CD4 cell count was 635 cells/μl. Across menopause, LDL, HDL, CRP, vitamin D and PTH significantly increased, while ASMI, FFMI, lumbar BMD, TBS score and FRAX® score worsened (P<0.001). In GEE models, independent predictors of BMD and TBS changes were time from menopause and calcium concentration; waist circumference was positively correlated with BMD and negatively correlated with TBS. TDF and PI/c/r were not predictors of BMD and TBS changes.
Conclusions: BMD and TBS remained stable in the pre-menopause period. Bone loss was more rapid in the early than late menopausal period, captured both with BMD and TBS. Current TDF or PI/c/r exposure was not independently associated with either BMD or TBS lowering in menopause.
