Bone mineral density declines twice as fast among HIV-positive women as HIV-positive men, according to an Italian study published online Journal of Acquired Immune Deficiency Syndromes. The study is the largest analysis of long-term changes in bone mineral density (BMD) in HIV-positive patients in the number of people, with more than three quarters with undetectable viral load already at baseline.
Several other modifiable risk factors have also been associated with reduced BMD, including hepatitis C virus (HCV) infection, tenofovir (PTO), low levels of vitamin D and lack of exercise.
"In a large cohort of HIV-infected men and women undergoing HAART [long-term antiretroviral therapy], femoral and lumbar spine BMD, two important predictors of fracture risk, declined twice as fast among women infected with With men living the same condition, even after adjusting for other variables"Write the authors.
"Remarkably, the majority of our study population was less than 50 years and only 15% of the participants were menopausal women at the baseline and 24% during follow-up. Thus, with aging and menopause, the rate of decline in BMD among HIV-infected women should be further accentuated, as suggested by our differences based on sex * and time cofactors. "
Declines in BMD during the first three years after starting ART are well described in the medical literature. However, rates of bone loss and its risk factors are less clear. Researchers from the Modena Clinical Clinic, thus, a study involving 839 women and 1759 men undergoing long-term ART. BMD was measured every six months and every 12 months using dual energy X-rays (DXA) capable of predicting BMD loss within 10 years.
The researchers calculated annual rates of BMD decrease in femoral neck (hip) and lumbar spine and associated factors. Statistical models included demographic data and HIV-related factors.
A final model was added to evaluate the interaction between sex and duration of therapy (sex * time) on bone loss.
Participants had a minimum of two DXA readings (median 5) over an average of five years of follow-up. All participants were white, 82% were younger than 50 years, and 76% had an undetectable viral load at baseline. About one-third (30% of women and 27% of men) had co-infection with HCVV (hepatitis C virus).
At the entrance to the study, 7% of men had low testosterone and 15% of women were postmenopausal, with a quarter of women classified as postmenopausal at any point of follow-up.
A baseline of the median BMD for the entire cohort was from 1,138 to total 0,833 in the femoral neck and 1,055 in the lumbar spine.
In the initial analysis, BMD in the femoral neck decreased significantly more among females than did males (-0.0353, p <0,0001), however there was no gender difference in BMD changes in the lumbar spine.
BMD of the lower femoral neck was also associated with increased exposure to tenofovir, increased age, lack of physical activity, low testosterone or post-menopausal status, vitamin D insufficiency and co-infection with HCV.
Protective factors included in view of the longer duration of treatment with an integrase inhibitor and a higher body mass index (BMI).
When researchers introduced the "sex * time" interaction in the model, annual changes in BMD were significantly higher among females than among males in both femoral neck (-0.00897-0.00422 vs., <0,001) and lumbar spine (-0.0127 vs. + 0.00765, p <0,001).
"In the largest and longest study of BMD changes among HIV-infected men and women to date, we have found almost double the rate of decline in BMD among HIV-infected women compared to men," the researchers note.
"Our results highlight BMD losses among women, regardless of menopause, effects that require future consideration in the selection of ART."
They also noted that several modifiable risk factors were associated with bone loss that could potentially be slowed down by possibly HCV therapy, vitamin D, choice of anti-HIV therapy and exercise.
"Low BMD is one of several risk factors for fracture," the researchers conclude.
"Therefore, interventions that may have a greater impact on the aging population are those that attenuate the loss of BMD and seek to minimize the risk of fractures by reducing falls."
I, Claudio Souza, have passed my fiftieth year, and I have gone fast (until God has another idea for me) for the 65 years and, advised by my dear Mara, not having seen any more trousers standing, as I had in the past. I sit down and put one leg at a time (naturally) and I do not take risks. The key to our survival of over twenty years with HIV is precisely this:
"Be cautious in everything"
Erlandsom KM et al. Bone mineral density declines twice as quickly as HIV-infected women compared to men. J Acquir Immune Defic Syndr, online edition. DOI: 10.1097 / QAI.0000000000001591 (2017).
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