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T Yin M, RoyChoudhury A, Nishiyama K, Lang T, Shah J, Olender S, Ferris DC, Zeana C, Sharma A, Zingman B, Bucovsky M, Colon I, Shane E. Bone density and microarchitecture in hepatitis C and HIV-coinfected postmenopausal minority women. Osteoporos Int 2018; 29:871-879. [PMID: 29387910 DOI: 10.1007/s00198-017-4354-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 12/17/2017] [Indexed: 01/17/2023]
Abstract
UNLABELLED We found that HIV+/HCV+ women had 7-8% lower areal bone mineral density (aBMD) by dual-energy x-ray absorptiometry (DXA) at the spine, hip, and radius (p < 0.01) and 5-7% lower volumetric BMD (vBMD) by central quantitative computed tomography (cQCT) at the spine and hip (p < 0.05). These data suggest that true deficits in vBMD may contribute to bone fragility and excess fractures reported in HIV+/HCV+ women. INTRODUCTION aBMD by DXA is lower in persons coinfected with HIV and HCV (HIV+/HCV+) than with HIV monoinfection (HIV+). However, weight is often also lower with HCV infection, and measurement of aBMD by DXA can be confounded by adiposity; we aimed to determine whether true vBMD is also lower in HIV+/HCV+ coinfection. METHODS We measured aBMD of the lumbar spine (LS), total hip (TH), femoral neck (FN), and ultradistal radius (UDR) by DXA and vBMD of the spine and hip by cQCT and of the distal radius and tibia by high-resolution peripheral QCT (HRpQCT) in 37 HIV+/HCV+ and 119 HIV+ postmenopausal women. Groups were compared using Student's t tests with covariate adjustment by multiple regression analysis. RESULTS HIV+/HCV+ and HIV+ women were of similar age and race/ethnicity. HIV+/HCV+ women had lower body mass index (BMI) and trunk fat and were more likely to smoke and less likely to have a history of AIDS. In HIV+/HCV+ women, aBMD by DXA was 7-8% lower at the LS, TH, and UDR (p < 0.01). Similarly, vBMD by cQCT was 5-7% lower at the LS and TH (p < 0.05). Between-group differences in LS aBMD and vBMD remained significant after adjustment for BMI, smoking, and AIDS history. Tibial total vBMD by HRpQCT was 10% lower in HIV+/HCV+ women. CONCLUSION HIV+/HCV+ postmenopausal women had significantly lower spine aBMD and vBMD. These deficits in vBMD may contribute to bone fragility and excess fractures reported in HIV+/HCV+ women.
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Affiliation(s)
- M T Yin
- Columbia University Medical Center, 630 w168th street, New York, NY, 10032, USA.
| | - A RoyChoudhury
- Cornell University Joan and Sanford I Weill Medical College, New York, NY, USA
| | - K Nishiyama
- Columbia University Medical Center, 630 w168th street, New York, NY, 10032, USA
| | - T Lang
- University of California San Francisco, San Francisco, CA, USA
| | - J Shah
- Columbia University Medical Center, 630 w168th street, New York, NY, 10032, USA
| | - S Olender
- Columbia University Medical Center, 630 w168th street, New York, NY, 10032, USA
| | - D C Ferris
- Bronx-Lebanon Hospital Center, Bronx, NY, USA
| | - C Zeana
- Bronx-Lebanon Hospital Center, Bronx, NY, USA
| | - A Sharma
- Montefiore, Yeshiva University Albert Einstein College of Medicine, Bronx, NY, USA
| | - B Zingman
- Montefiore, Yeshiva University Albert Einstein College of Medicine, Bronx, NY, USA
| | - M Bucovsky
- Columbia University Medical Center, 630 w168th street, New York, NY, 10032, USA
| | - I Colon
- Columbia University Medical Center, 630 w168th street, New York, NY, 10032, USA
| | - E Shane
- Columbia University Medical Center, 630 w168th street, New York, NY, 10032, USA
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Tan DHS, Raboud J, Szadkowski L, Szabo E, Hu H, Wong Q, Cheung AM, Walmsley SL. Novel imaging modalities for the comparison of bone microarchitecture among HIV+ patients with and without fractures: a pilot study. HIV CLINICAL TRIALS 2016; 18:28-38. [PMID: 27951753 DOI: 10.1080/15284336.2016.1266074] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND HIV-infected adults have increased fracture risk. OBJECTIVES To generate pilot data comparing bone density, structure, and strength between HIV-infected adults with and without a prior fracture. METHODS Adults with and without a prior fracture after their HIV diagnosis were matched 1:1 based on age, sex, race, and smoking history. Participants underwent dual-energy X-ray absorptiometry (DXA), trabecular bone score (TBS), hip structural analyses (HSA), vertebral fracture assessment (VFA), high-resolution peripheral quantitative tomography (HR-pQCT) and measurement of bone turnover markers. Results were compared between cases and controls, with differences expressed as percentages of control group values. RESULTS 23 pairs were included. On DXA, cases had lower areal bone mineral density (aBMD) at the total hip (median difference in T-score -0.25, p = 0.04), but not the lumbar spine (median difference in T-score 0.10, p = 0.68). Cases had greater abnormalities in HSA and most HR-pQCT and HSA measures, by up to 15%. VFA revealed two subclinical fractures among cases but none among controls. TBS, CTX, and P1NP levels were similar between groups, with differences of 1.9% (p = 0.90), 9.7% (p = 0.55), and 10.0% (p = 0.24), respectively. For each parameter, we report the median and interquartile range for the absolute and relative difference between cases and controls, the correlation between cases and controls, and our recruitment rates, to inform the design of future studies. CONCLUSIONS These pilot data suggest potential differences in bone structure, estimated bone strength, and asymptomatic vertebral fractures among HIV-infected adults with and without fracture, warranting further study as markers of fracture risk in HIV.
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Affiliation(s)
- Darrell H S Tan
- a Division of Infectious Diseases , St. Michael's Hospital , Toronto , Canada.,b Division of Infectious Diseases , University Health Network , Toronto , Canada.,c Toronto General Research Institute , University Health Network , Toronto , Canada.,d Department of Medicine , University of Toronto , Toronto , Canada.,e CIHR - Canadian HIV Trials Network , Vancouver , Canada
| | - Janet Raboud
- c Toronto General Research Institute , University Health Network , Toronto , Canada.,f Dalla Lana School of Public Health , University of Toronto , Toronto , Canada
| | - Leah Szadkowski
- c Toronto General Research Institute , University Health Network , Toronto , Canada
| | - Eva Szabo
- g Centre for Excellence in Skeletal Health Assessment , University Health Network , Toronto , Canada
| | - Hanxian Hu
- g Centre for Excellence in Skeletal Health Assessment , University Health Network , Toronto , Canada
| | - Queenie Wong
- g Centre for Excellence in Skeletal Health Assessment , University Health Network , Toronto , Canada
| | - Angela M Cheung
- c Toronto General Research Institute , University Health Network , Toronto , Canada.,d Department of Medicine , University of Toronto , Toronto , Canada.,f Dalla Lana School of Public Health , University of Toronto , Toronto , Canada.,g Centre for Excellence in Skeletal Health Assessment , University Health Network , Toronto , Canada.,h Divisions of General Internal Medicine and Endocrinology , University Health Network , Toronto , Canada
| | - Sharon L Walmsley
- b Division of Infectious Diseases , University Health Network , Toronto , Canada.,c Toronto General Research Institute , University Health Network , Toronto , Canada.,d Department of Medicine , University of Toronto , Toronto , Canada.,e CIHR - Canadian HIV Trials Network , Vancouver , Canada
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Yin MT, Brown TT. HIV and Bone Complications: Understudied Populations and New Management Strategies. Curr HIV/AIDS Rep 2016; 13:349-358. [PMID: 27730445 DOI: 10.1007/s11904-016-0341-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The higher risk of osteoporosis and fracture associated with HIV infection and certain antiretrovirals has been well established and the need for risk stratification among older adults increasingly recognized. This review focuses upon emerging data on bone complications with HIV/HCV coinfection, in children and adolescents, and with pre-exposure prophylaxis (PrEP), as well as new management strategies to minimize the negative effects of ART on bone.
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Affiliation(s)
- Michael T Yin
- Division of Infectious Diseases, Columbia University Medical Center, 630 w168th street PH8-876, New York, NY, 10032, USA.
| | - Todd T Brown
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, 1830 East Monument Street, Suite 333, Baltimore, MD, 21287, USA
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Mazzotta E, Ursini T, Agostinone A, Di Nicola AD, Polilli E, Sozio F, Vadini F, Pieri A, Trave F, De Francesco V, Capasso L, Borderi M, Manzoli L, Viale P, Parruti G. Prevalence and predictors of low bone mineral density and fragility fractures among HIV-infected patients at one Italian center after universal DXA screening: sensitivity and specificity of current guidelines on bone mineral density management. AIDS Patient Care STDS 2015; 29:169-80. [PMID: 25692868 DOI: 10.1089/apc.2014.0205] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Low bone mineral density (BMD) is frequent in HIV infection regardless of the use of antiretroviral therapy (ART). Uncertainties remain, however, as to when in HIV infection BMD screening should be performed. We designed a prospective study to estimate the efficacy of universal BMD screening by dual-energy X-ray absorptiometry (DXA). Since April 2009 through March 2011, HIV patients attending our Center were offered femoral/lumbar DXA to screen BMD. Low BMD for chronological age, that is significant osteopenia, was defined as a Z-score ≤ -2.0 at femur and lumbar spine. Nontraumatic bone fractures (NTBFs) were evaluated. The final sample included 163 patients. A Z-score ≤ -2.0 at any site was observed in 19.6% of cases: among these, 18.8% had no indication to DXA using current Italian HIV guidelines for BMD screening. A lower femoral Z-score was independently associated with lower BMI, AIDS diagnosis, HCV co-infection, antiretroviral treatment, and NTBFs; a lower lumbar Z-score with age, BMI, Nadir CD4 T-cell counts, and NTBFs. Prevalence of NTBFs was 27.0%, predictors being male gender, HCV co-infection, and lower femoral Z-scores. Our results suggest that measuring BMD by DXA in all HIV patients regardless of any further specification may help retrieving one-fifth of patients with early BMD disorders not identified using current criteria for selective screening of BMD.
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Affiliation(s)
- Elena Mazzotta
- University of Chieti “Gabriele D'Annunzio”, Chieti, Italy
| | - Tamara Ursini
- University of Chieti “Gabriele D'Annunzio”, Chieti, Italy
| | | | | | - Ennio Polilli
- Microbiology and Virology Unit, Pescara General Hospital, Pescara, Italy
| | - Federica Sozio
- Infectious Disease Unit, Pescara General Hospital, Pescara, Italy
| | - Francesco Vadini
- Infectious Disease Unit, Pescara General Hospital, Pescara, Italy
| | - Alessandro Pieri
- Infectious Disease Unit, Pescara General Hospital, Pescara, Italy
| | - Francesca Trave
- Infectious Disease Unit, Pescara General Hospital, Pescara, Italy
| | | | - Lorenzo Capasso
- Department of Medicine and Aging Sciences, University of Chieti-Pescara “Gabriele D'Annunzio”, Chieti, Italy
| | - Marco Borderi
- Department of Medical and Surgical Sciences, Section of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Lamberto Manzoli
- Department of Medicine and Aging Sciences, University of Chieti-Pescara “Gabriele D'Annunzio”, Chieti, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Section of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Giustino Parruti
- Infectious Disease Unit, Pescara General Hospital, Pescara, Italy
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Lo Re V, Lynn K, Stumm ER, Long J, Nezamzadeh MS, Baker JF, Hoofnagle AN, Kapalko AJ, Mounzer K, Zemel BS, Tebas P, Kostman JR, Leonard MB. Structural Bone Deficits in HIV/HCV-Coinfected, HCV-Monoinfected, and HIV-Monoinfected Women. J Infect Dis 2015; 212:924-33. [PMID: 25754980 DOI: 10.1093/infdis/jiv147] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/02/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coinfection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) is associated with reduced bone mineral density (BMD) and increased fracture rates, particularly in women. The structural underpinnings for skeletal fragility in coinfected women have not been characterized. We used tibial peripheral quantitative computed tomography to evaluate skeletal parameters in women, by HIV/HCV status. METHODS We conducted a cross-sectional study among 50 HIV/HCV-coinfected, 51 HCV-monoinfected, and 50 HIV-monoinfected women. Tibial volumetric BMD and cortical dimensions were determined with peripheral quantitative computed tomography. Race-specific z scores for age were generated using 263 female reference participants without HIV infection or liver disease. RESULTS Coinfected participants had lower mean z scores for trabecular volumetric BMD (-0.85), cortical volumetric BMD (-0.67), cortical area (-0.61), and cortical thickness (-0.77) than reference participants (all P < .001). The smaller cortical dimensions were due to greater mean z scores for endosteal circumference (+0.67; P < .001) and comparable z scores for periosteal circumference (+0.04; P = .87). Trabecular volumetric BMD was lower in coinfected than in HCV- or HIV-monoinfected participants. HCV-infected women with stage 3-4 liver fibrosis had lower mean z scores for trabecular volumetric BMD, cortical thickness, and total hip BMD those with stage 0-2 fibrosis. CONCLUSIONS Compared with healthy reference patients, HIV/HCV-coinfected women had decreased tibial trabecular volumetric BMD, diminished cortical dimensions, and significant endocortical bone loss.
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Affiliation(s)
- Vincent Lo Re
- Division of Infectious Diseases Division of Center for AIDS Research Division of Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology
| | - Kenneth Lynn
- Division of Infectious Diseases Division of Center for AIDS Research
| | - Emily R Stumm
- Division of Infectious Diseases Division of Center for AIDS Research
| | - Jin Long
- Healthcare Analytics Unit, Children's Hospital of Philadelphia
| | - Melissa S Nezamzadeh
- Division of Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology
| | | | | | | | - Karam Mounzer
- Jonathan Lax Treatment Center, Philadelphia FIGHT, Pennsylvania
| | - Babette S Zemel
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, and Children's Hospital of Philadelphia
| | - Pablo Tebas
- Division of Infectious Diseases Division of Center for AIDS Research
| | - Jay R Kostman
- Division of Infectious Diseases Division of Center for AIDS Research
| | - Mary B Leonard
- Division of Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology Department of Pediatrics and Medicine, Stanford University, California
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Hip structural parameters over 96 weeks in HIV-infected adults switching treatment to tenofovir-emtricitabine or abacavir-lamivudine. PLoS One 2014; 9:e94858. [PMID: 24722774 PMCID: PMC3983265 DOI: 10.1371/journal.pone.0094858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 03/19/2014] [Indexed: 11/19/2022] Open
Abstract
Background Therapy with tenofovir is associated with lower bone mineral density (BMD), higher markers of bone turnover and increased fracture risk in HIV-infected adults. Bone structural parameters generated by hip structural analysis may represent a separate measure of bone strength, but have not been assessed in HIV. Methods Dual-energy X-ray absorptiometry (DXA) scans from 254 HIV-infected adults randomised to simplify their existing dual nucleoside analogue reverse transcriptase inhibitor therapy to coformulated tenofovir-emtricitabine or abacavir-lamivudine were analysed using DXA-derived hip structural analysis software. Hip structural parameters included femoral strength index, section modulus, cross-sectional area, and cross-sectional moment of inertia. We used one-way ANOVA to test the relationship between nucleoside analogue type at baseline and structural parameters, multivariable analysis to assess baseline covariates associated with femoral strength index, and t-tests to compare mean change in structural parameters over 96 weeks between randomised groups. Results Participants taking tenofovir at baseline had lower section modulus (−107.3 mm2, p = 0.001), lower cross-sectional area (−15.01 mm3, p = 0.001), and lower cross-sectional moment of inertia (−2,036.8 mm4, p = 0.007) than those receiving other nucleoside analogues. After adjustment for baseline risk factors, the association remained significant for section modulus (p = 0.008) and cross-sectional area (p = 0.002). Baseline covariates significantly associated with higher femoral strength index were higher spine T-score (p = 0.001), lower body fat mass (p<0.001), lower bone alkaline phosphatase (p = 0.025), and higher osteoprotegerin (p = 0.024). Hip structural parameters did not change significantly over 96 weeks and none was significantly affected by treatment simplification to tenofovir-emtricitabine or abacavir-lamivudine. Conclusion In this population, tenofovir use was associated with reduced composite indices of bone strength as measured by hip structural analysis, but none of the structural parameters improved significantly over 96 weeks with tenofovir cessation. Trial Registration ClinicalTrials.gov NCT00192634
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Abstract
OBJECTIVE(S) Some but not all studies indicate that individuals with HIV infection are at an increased risk of fracture. We systematically reviewed the literature to investigate whether incidence of fracture (both overall and fragility) differs between individuals with and without HIV. DESIGN A systematic review and meta-analysis. METHODS Medline, Scopus and the Cochrane Library databases for all studies ever published up to 28 September 2012 and electronically available conference abstracts from CROI, ASBMR, IAS and AIDS were searched. All studies reporting incidence of all fracture and fragility fracture in HIV-infected adults were included. A random effects model was used to calculate pooled estimates of incidence rate ratios (IRRs) for studies that presented data for HIV-infected and controls. For all studies, incidence rates of fracture and predictors of fracture among HIV-infected individuals were summarized. RESULTS Thirteen eligible studies were analysed, of which seven included controls. Nine studies reported all incident fractures and 10 presented incident fragility fractures. The pooled IRR was 1.58 [95% confidence interval (CI) 1.25-2.00] for all fracture and 1.35 (95% CI 1.10-1.65) for fragility fracture. Smoking, white race and older age were consistent predictors for fragility fractures. CONCLUSION Our results indicate that HIV infection is associated with a modest increase in incident fracture. Future research should focus on clarifying risk factors, designing appropriate interventions and the long-term implications of this increased risk for an ageing HIV-infected population.
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Current world literature. Curr Opin Rheumatol 2012; 24:586-94. [PMID: 22871955 DOI: 10.1097/bor.0b013e32835793df] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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