Evaluation of Bone Mineral Density in Iranian HIV/AIDS Patients
Abstract
Bone disorders have emerged as a worrisome complication in HIV-infected patients in recent years. It is not clear that HIV infection itself or antiretroviral treatment or both are causes of bone loss. However, most studies have found a high prevalence of osteopenia and osteoporosis in HIV/AIDS patients. The objectives of this study were to determine the prevalence of osteopenia and osteoporosis in HIV-infected patients either untreated or receiving Highly Active Antiretroviral Therapy as compared with HIV negative persons. We also assessed the factors associated with these conditions. Bone Mineral Density was assessed by Dual Energy X-Ray Absorptiometry scans at the hip and lumbar spine in 36 AIDS patients receiving antiretroviral therapy and 44 HIV infected patients not receiving antiretroviral therapy (naïve patients) and 40 HIV negative individuals as control. Factors that affect BMD were also determined. Prevalence of osteopenia or osteoporosis in different regions was significantly higher in HIV/AIDS patients compared with HIV negative subjects (77.3% in HIV positive naïve patients, 86.1% in HAART-treated patients and 60% in the control group, P=0.002). Mean serum alkaline phosphatase was higher in HIV/AIDS patients than the control group (P=0.003). Osteopenia and osteoporosis in HIV-infected patients were associated with duration of HIV infection (P<0.0001) and antiretroviral treatment (P=0.012). Prevalence of osteopenia and osteoporosis in HIV/AIDS patients was higher than HIV negative individuals. Osteopenia and osteoporosis in HIV/AIDS patients was associated with duration of HIV infection and antiretroviral treatment.
Hammer SM, Squires KE, Hughes MD, Grimes JM, Demeter LM, Currier JS, Eron JJ Jr, Feinberg JE, Balfour HH Jr, Deyton LR, Chodakewitz JA, Fischl MA. A controlled trial of two nucleoside analogues plus indinavir in persons with human immunodeficiency virus infection and CD4 cell counts of 200 per cubic millimeter or less. AIDS Clinical Trials Group 320 Study Team. N Engl J Med 1997; 337(11):725-33.
Palella FJ Jr, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, Aschman DJ, Holmberg SD. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 1998; 338(13):853-60.
Brinkman K, ter Hofstede HJ, Burger DM, Smeitink JA, Koopmans PP. Adverse effects of reverse transcriptase inhibitors: mitochondrial toxicity as common pathway. AIDS 1998; 12(14):1735-44.
Tebas P. Osteopenia, osteoporosis, and other bone problems in HIV-infected individuals. Physicians' Res Net 6(3); 2001:12-7.
Grinspoon SK, Bilezikian JP. HIV disease and the endocrine system. N Engl J Med 1992; 327(19):1360-5.
Meyer D, Behrens G, Schmidt RE, Stoll M. Osteonecrosis of the femoral head in patients receiving HIV protease inhibitors. AIDS 1999; 13(9):1147-8.
Stephens EA, Das R, Madge S, Barter J, Johnson MA. Symptomatic osteoporosis in two young HIV-positive African women. AIDS 1999; 13(18):2605-6.
Romeyn M, Ireland J. Bone loss in HIV: Not a proteaseinhibitor effect. 4th International Conference on Nutrition and HIV Infection, Cannes, France, 2001.
Moore AL, Vashisht A, Sabin CA, Mocroft A, Madge S, Phillips AN, Studd JW, Johnson MA. Reduced bone mineral density in HIV-positive individuals. AIDS 2001; 15(13):1731-3.
McGowan I, Cheng A, Coleman S, Johnson A, Genant H; Conference on Retroviruses and Opportunistic Infections. [online] 2001 Feb [ cited 2011 Jun 15]; Program Abstract, 8th Conf Retrovir Oppor Infect Conf, Chic Ill. 4-8;8:233. Available from: URL:http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f= 102244412.html
Knobel H, Guelar A, Vallecillo G, Nogués X, Díez A.Osteopenia in HIV-infected patients: is it the disease or is it the treatment? AIDS 2001; 15(6):807-8.
Negredo E, Gel S, Arisa ER, Rosales J, Paredes R, Del Rio L, Balague M, Johnston S, Sirera G, Tural C, Bonjoch A, Jou A, Cruz L, Clotet B; Conference on Retroviruses and Opportunistic Infections. Bone mineral density (BMD) in HIV-1-infected patients. [online] 2001 Feb [cited 2011 Jun 15]; Program Abstract, 8th Conf Retrovir Oppor Infect Conf, 2001 Chic Ill. 4-8;8:232. Available from: URL:http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f= 102244410.html
Lawal A, Engelson ES, Wang J, Heymsfield SB, Kotler DP. Equivalent osteopenia in HIV-infected individuals studied before and during the era of highly active antiretroviral therapy. AIDS 2001; 15(2):278-80.
Thomas J, Doherty SM. HIV infection: a risk factor for osteoporosis. J Acquir Immune Defic Syndr 2003; 33(3):281-91.
Anastos K, Lu D, Shi O, Mulligan K, Tien PC, Freeman R, Cohen MH, Justman J, Hessol NA. The association ofbone mineral density with HIV infection and antiretroviral treatment in women. Antivir Ther 2007; 12(7):1049-58.
Tebas P, Powderly WG, Claxton S, Marin D, Tantisiriwat W, Teitelbaum SL, Yarasheski KE. Accelerated bone mineral loss in HIV-infected patients receiving potent antiretroviral therapy. AIDS 2000; 14(4):F63-7.
Paton NI, Macallan DC, Griffin GE, Pazianas M. Bone mineral density in patients with human immunodeficiency virus infection. Calcif Tissue Int 1997; 61(1):30-2.
Mondy K, Yarasheski K, Powderly WG, Whyte M, Claxton S, DeMarco D, Hoffmann M, Tebas P. Longitudinal evolution of bone mineral density and bone markers in human immunodeficiency virus-infected individuals. Clin Infect Dis 2003; 36(4):482-90.
Chang K, Kim J, Hong S, Song Y, Lee H, Lim S; Conference on Retroviruses and Opportunistic Infections. [online] 2001 Feb [ cited 2011 Jun 15]; Program Abstract, 8th Conf Retrovir Oppor Infect Conf, Chic Ill. 4-8;8:233. Available from: URL:http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f= 102244414.html
Riggs BL, Melton LJ 3rd. The prevention and treatment of osteoporosis. N Engl J Med 1992; 327(9):620-7.
Erikson EF, Berg NJ, Graham ML, Colvard DS, Mann KG, Spelsberg TC, Riggs BL. Multiple sex steroid receptors in cultured human osteoblast-like cells. In: Christiansen C, Johansen JS, Riis BJ, editors. International Symposium on Osteoporosis, Denmark, 1987.
Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser 1994; 843:1-129.
Kanis JA, Melton LJ 3rd, Christiansen C, Johnston CC, Khaltaev N. The diagnosis of osteoporosis. J Bone Miner Res 1994; 9(8):1137-41.
Schambelan M, Benson CA, Carr A, Currier JS, Dubé MP, Gerber JG, Grinspoon SK, Grunfeld C, Kotler DP, Mulligan K, Powderly WG, Saag MS; International AIDS Society-USA. Management of metabolic complications associated with antiretroviral therapy for HIV-1 infection: recommendations of an International AIDS Society-USA panel. J Acquir Immune Defic Syndr 2002; 31(3):257-75.
Baran DT, Faulkner KG, Genant HK, Miller PD, Pacifici R. Diagnosis and management of osteoporosis: guidelines for the utilization of bone densitometry. Calcif Tissue Int 1997; 61(6):433-40.
Miller PD, Zapalowski C, Kulak CA, Bilezikian JP. Bone densitometry: the best way to detect osteoporosis and to monitor therapy. J Clin Endocrinol Metab 1999; 84(6):1867-71.
Files | ||
Issue | Vol 49, No 7 (2011) | |
Section | Original Article(s) | |
Keywords | ||
Osteopenia Osteoporosis Bone Mineral Density HIV AIDS Antiretroviral drugs |
Rights and permissions | |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |