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Longitudinal Analysis of Bone Density in Human Immunodeficiency Virus-Infected Women

Program in Nutritional Metabolism (S.E.D., J.R.K., S.G.), Massachusetts General Hospital, and Harvard Medical School (S.G.), Boston, Massachusetts 02114

Address all correspondence and requests for reprints to: Steven Grinspoon, M.D., Program in Nutritional Metabolism, Massachusetts General Hospital, 55 Fruit Street, LON207, Boston, Massachusetts 02114. E-mail: sgrinspoon{at}partners.org.

Objectives: The objective of the study was to investigate change in bone mineral density (BMD) over time in HIV-infected women in comparison with healthy control subjects similar in age, race, and body mass index (BMI).

Design: This was a prospective cohort study.

Methods: BMD was measured by dual-energy x-ray absorptiometry in 100 HIV-infected females and 100 healthy controls similar in age (41 ± 1 vs. 41 ± 1 yr, P = 0.57), BMI (26.1 ± 0.5 vs. 27.2 ± 0.4 kg/m², P = 0.12), and race (60 vs. 65% non-Caucasian, P = 0.47, HIV-infected vs. controls). Changes in BMD were determined every 6 months over 24 months.

Results: At baseline, HIV-infected subjects had lower BMD at the lumbar spine (1.01 ± 0.01 vs. 1.07 ± 0.01 g/cm², P = 0.001), hip (0.94 ± 0.01 vs. 0.98 ± 0.01 g/cm², P = 0.02), and femoral neck (0.83 ± 0.01 vs. 0.87 ± 0.01 g/cm², P = 0.02). Historical low weight, duration of nucleoside reverse transcriptase inhibitor use, and FSH were significantly associated with lumbar BMD, whereas duration of HIV, BMI, historical low weight, smoking pack-years, N-telopeptide of type 1 collagen, viral load, 25 hydroxyvitamin D, and osteocalcin were associated with hip BMD at baseline. In mixed model longitudinal analyses, BMD remained lower in HIV-infected subjects than in controls over 24 months of follow-up (P = 0.001 for the spine, P = 0.04 for the hip, and P = 0.02 for the femoral neck). These differences remained significant controlling for age, race, BMI, and menstrual function. In contrast, rates of change for the spine (P = 0.79), hip (P = 0.44), and femoral neck (P = 0.34) were not different between the HIV and control groups over 2 yr. In the HIV group, longitudinal changes in BMD were not associated with current protease inhibitor, nucleoside reverse transcriptase inhibitor, or non-nucleoside reverse transcriptase inhibitor use but were associated with CD4 count, weight, FSH, N-telopeptide of type 1 collagen, and baseline BMD.

Conclusions: BMD is reduced at the spine, hip, and femoral neck among women with HIV in relationship to low weight, duration of HIV, smoking, and increased bone turnover. Over 2 yr of follow-up, BMD remained stable but lower in HIV-infected women, compared with control subjects.

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