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Low Bone Mineral Density, Renal Dysfunction, and Fracture Risk in HIV Infection: A Cross-Sectional Study

Calmy, Alexandra ; Fux, Christoph A. ; Norris, Richard ; Vallier, Nathalie ; Delhumeau, Cécile ; Samaras, Katherine ; Hesse, Karl ; Hirschel, Bernard ; Cooper, David A. ; Carr, Andrew

In: The Journal of Infectious Diseases, 2009, vol. 200, no. 11, p. 1746-1754

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    Titel
    • Low Bone Mineral Density, Renal Dysfunction, and Fracture Risk in HIV Infection: A Cross-Sectional Study
    Autor
    • Calmy, Alexandra. HIV, Immunology and Infectious Diseases Unit and
    • Fux, Christoph A.. University Clinic for Infectious Diseases and University of Berne, Switzerland
    • Norris, Richard. HIV, Immunology and Infectious Diseases Unit and
    • Vallier, Nathalie. HIV Unit, Geneva University Hospital, Geneva, and
    • Delhumeau, Cécile. HIV Unit, Geneva University Hospital, Geneva, and
    • Samaras, Katherine. Garvan Institute for Medical Research, and
    • Hesse, Karl. HIV, Immunology and Infectious Diseases Unit and
    • Hirschel, Bernard. HIV Unit, Geneva University Hospital, Geneva, and
    • Cooper, David A.. HIV, Immunology and Infectious Diseases Unit and
    • Carr, Andrew. HIV, Immunology and Infectious Diseases Unit and
    Dokumententyp
    • Postprint
    Sprache
    • Englisch
    Veröffentlicht in
    • The Journal of Infectious Diseases, 2009, vol. 200, no. 11, p. 1746-1754. The University of Chicago Press
    Andere elektronische Ausgabe
    Klassifikation
    • Gesundheit
    OAI-PMH-ID
    • oai:doc.rero.ch:299373
    Summary
    BackgroundReduced bone mineral density (BMD) is common in adults infected with human immunodeficiency virus (HIV). The role of proximal renal tubular dysfunction (PRTD) and alterations in bone metabolism in HIV-related low BMD are incompletely understood MethodsWe quantified BMD (dual-energy x-ray absorptiometry), blood and urinary markers of bone metabolism and renal function, and risk factors for low BMD (hip or spine T score, −1 or less) in an ambulatory care setting. We determined factors associated with low BMD and calculated 10-year fracture risks using the World Health Organization FRAX equation ResultsWe studied 153 adults (98% men; median age, 48 years; median body mass index, 24.5; 67 [44%] were receiving tenofovir, 81 [53%] were receiving a boosted protease inhibitor [PI]). Sixty-five participants (42%) had low BMD, and 11 (7%) had PRTD. PI therapy was associated with low BMD in multivariable analysis (odds ratio, 2.69; 95% confidence interval, 1.09-6.63). Tenofovir use was associated with increased osteoblast and osteoclast activity (P⩽.002). The mean estimated 10-year risks were 1.2% for hip fracture and 5.4% for any major osteoporotic fracture ConclusionsIn this mostly male population, low BMD was significantly associated with PI therapy. Tenofovir recipients showed evidence of increased bone turnover. Measurement of BMD and estimation of fracture risk may be warranted in treated HIV-infected adults