Reduced bone density in HIV-infected women

Objectives: Although bone density has been previously investigated in HIV-infected men, little is known regarding bone density in HIV-infected women. Methods and design: Bone density was measured by dual-energy X-ray absorptiometry in 84 ambulatory, HIV-infected females and 63 healthy female control subjects similar in age (41 ± 1 versus 41 ± 1 years, P= 0.83), body mass index (26.0 ± 0.6 versus 27.0 ± 0.5 kg/m 2 , P=0.44) and racial background (% non-Caucasian, 61 versus 51%; P = 0.24, HIV-infected versus control). Results: Lumbar spine (1.02 ± 0.02 versus 1.07 ± 0.02 g/cm 2 , P = 0.03) and total hip (0.93±0.01 versus 0.99±0.01 g/cm 2 , P= 0.004) bone density were reduced in HIV-infected compared with control subjects. Osteopenia was demonstrated in 54 versus 30% (P= 0.004) of HIV-infected versus control subjects and was 2.5 times more likely in a multivariate model accounting for age, race, menstrual function and body mass index. Urinary N-telopeptides of type 1 collagen (NTx) (39.6±3.5 versus 29.9 ±2.0 nM/mM urine creatinine, P=0.03) and osteoprotegerin (4.76±0.23 versus 3.39±0.17 pmol/l, P≤0.0001) were increased in HIV-infected compared with control subjects. Among the HIV-infected women, bone density correlated with weight (r=0.41, P<0.001) and inversely with urinary NTx (r=-0.28, P=0.01). Bone density did not differ by current or past protease inhibitor, nucleoside reverse trancriptase inhibitor, or non-nucleoside reverse transcriptase inhibitor exposure. Conclusions: HIV-infected women demonstrate reduced bone density. Altered nutritional status, hormonal function and body composition may contribute to lower bone density in HIV-infected women. Consideration should be given to testing bone density in HIV-infected women with risk factors for osteopenia.