December 27, 2011

HIV Worsens Bone Loss After Menopause

NEW YORK (Reuters Health) Dec 22 - Compared to a control group, postmenopausal women with HIV infection had higher rates of bone loss and could well have a higher risk for fracture as they age, according to the researchers who conducted the study.

Studies of mainly younger HIV-positive patients have shown that bone mineral density (BMD) often declines after the start of antiretroviral therapy but then seems to stabilize, suggesting that patients don't need additional screening or fracture prevention measures, the research team said in a November 16 online paper in the Journal of Clinical Endocrinology & Metabolism.

The older women in the current study were all Hispanic or African-American. Dr. Elizabeth Shane of Columbia University Medical Center, New York and colleagues had previously reported low BMD and higher levels of bone turnover markers in these women. Their new study focuses on a subset -- 73 HIV-positive and 55 HIV-negative women -- for whom they had an average of 16 months of longitudinal data.

On average, the HIV group was significantly younger (56 vs 59 years), with a significantly lower body mass index (28 vs 31). After allowing for this, they had increased rates of bone loss. Annualized, the increase was 2.4-fold at the lumbar spine, 3.7-fold at the one third radius, and 1.7-fold at the ultradistal radius.

Tenofovir therapy was associated with lower BMD. For example, in the tenofovir group, the drop at the lumbar spine was 2.8%, compared to 0.7% in those on a tenofovir-free regimen.

Rates of self-reported fracture were similar in the HIV and control groups (10% vs 8%).

The investigators say, "The higher rates of spine and forearm bone loss we observed in postmenopausal HIV positive women raise concern for rising fracture rates as our participants age."

The findings, they conclude, "merit risk stratification with dual-energy x-ray absorptiometry, assessment for modifiable secondary causes of osteoporosis, and appropriate treatment of osteoporosis for all postmenopausal HIV positive women."

SOURCE: http://bit.ly/v18g9E

J Clin Endocrinol Metab 2011.

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