This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Huang, J. S. Articles by Grinspoon, S. Search for Related Content PubMed PubMed Citation Articles by Huang, J. S. Articles by Grinspoon, S.

Reduced Bone Density in Androgen-Deficient Women with Acquired Immune Deficiency Syndrome Wasting

Neuroendocrine Unit (S.J.W., M.P.S., S.G.), Combined Program in Pediatric Gastroenterology and Nutrition (J.S.H.), Massachusetts General Hospital, Children’s Hospital, and Harvard Medical School, Boston, Massachusetts 02114

Address all correspondence and requests for reprints to: Steven Grinspoon, M.D., Neuroendocrine Unit, Massachusetts General Hospital, BUL 457B, 55 Fruit Street, Boston, Massachusetts 02114. E-mail: sgrinspoon{at}partners.org

Abstract

Women with acquired immune deficiency syndrome wasting are at an increased risk of osteopenia because of low weight, changes in body composition, and hormonal alterations. Although women comprise an increasing proportion of human immunodeficiency virus-infected patients, prior studies have not investigated bone loss in this expanding population of patients. In this study we investigated bone density, bone turnover, and hormonal parameters in 28 women with acquired immune deficiency syndrome wasting and relative androgen deficiency (defined as free testosterone 3.0 pg/ml, weight 90% ideal body weight, weight loss 10% from preillness maximum weight, or weight <100% ideal body weight with weight loss 5% from preillness maximum weight). Total body (1.04 ± 0.08 vs. 1.10 ± 0.07 g/cm², human immunodeficiency virus-infected vs. control respectively; P < 0.01), anteroposterior lumbar spine (0.94 ± 0.12 vs. 1.03 ± 0.09 g/cm²; P = 0.005), lateral lumbar spine (0.71 ± 0.14 vs. 0.79 ± 0.09 g/cm²; P = 0.02), and hip (Ward’s triangle; 0.68 ± 0.14 vs. 0.76 ± 0.12 g/cm²; P = 0.05) bone density were reduced in the human immunodeficiency virus-infected compared with control subjects. Serum N-telopeptide, a measure of bone resorption, was increased in human immunodeficiency virus-infected patients, compared with control subjects (14.6 ± 5.8 vs. 11.3 ± 3.8 nmol/liter bone collagen equivalents, human immunodeficiency virus-infected vs. control respectively; P = 0.03). Although body mass index was similar between the groups, muscle mass was significantly reduced in the human immunodeficiency virus-infected vs. control subjects (16 ± 4 vs. 21 ± 4 kg, human immunodeficiency virus-infected vs. control, respectively; P < 0.0001). In univariate regression analysis, muscle mass (r = 0.53; P = 0.004) and estrogen (r = 0.51; P = 0.008), but not free testosterone (r = -0.05, P = 0.81), were strongly associated with lumbar spine bone density in the human immunodeficiency virus-infected patients. The association between muscle mass and bone density remained significant, controlling for body mass index, hormonal status, and age (P = 0.048) in multivariate regression analysis.

These data indicate that both hormonal and body composition factors contribute to reduced bone density in women with acquired immune deficiency syndrome wasting. Anabolic strategies to increase muscle mass may be useful to increase bone density among osteopenic women with acquired immune deficiency syndrome wasting.

This article has been cited by other articles:

				M. J. Bolland, A. B. Grey, G. D. Gamble, and I. R. Reid Low Body Weight Mediates the Relationship between HIV Infection and Low Bone Mineral Density: A Meta-Analysis J. Clin. Endocrinol. Metab., December 1, 2007; 92(12): 4522 - 4528. [Abstract] [Full Text] [PDF]

				S. E. Dolan, J. R. Kanter, and S. Grinspoon Longitudinal Analysis of Bone Density in Human Immunodeficiency Virus-Infected Women J. Clin. Endocrinol. Metab., August 1, 2006; 91(8): 2938 - 2945. [Abstract] [Full Text] [PDF]

				T. T. Brown, M. D. Ruppe, R. Kassner, P. Kumar, T. Kehoe, A. S. Dobs, and J. Timpone Reduced Bone Mineral Density in Human Immunodeficiency Virus-Infected Patients and Its Association with Increased Central Adiposity and Postload Hyperglycemia J. Clin. Endocrinol. Metab., March 1, 2004; 89(3): 1200 - 1206. [Abstract] [Full Text] [PDF]