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Long-term trabecular bone score and bone mineral density changes in Chinese antiretroviral-treated HIV-infected individuals

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Abstract

Summary

This is the first 5-year analysis among persons with HIV (PWH) that reports both trabecular bone score (TBS), which is a novel index that estimates bone microarchitecture, and bone mineral density (BMD) over time to evaluate the long-term impact of antiretroviral therapy (ART) on bone health.

Purpose

HIV infection and antiretroviral therapy (ART) have been associated with decreased bone mineral density (BMD). This study aims to evaluate long-term changes in trabecular bone score (TBS), a novel index that estimates bone microarchitecture, and BMD among Chinese persons with HIV (PWH) treated with ART.

Methods

We conducted a retrospective chart review of adult PWH at a large tertiary care hospital in China. Patients who had a DXA scan prior to ART and at least one follow-up DXA after ART initiation were included. Subgroup analyses examined the TBS and BMD changes in patients who switch from a non-TDF-containing regimen to one containing TDF, as compared to those who did not switch.

Results

Four hundred fifty-nine PWH were included. Among 68 patients ≥ 50 years, 13 patients (19.1%) had a normal BMD but partially degraded or degraded TBS. The mean percent decrease in lumbar spine (LS) BMD nadired at 48 weeks after ART initiation and then gradually improved. Percent decrease in femoral neck (FN) and total hip (TH) BMD nadired at 96 weeks and remained stably low thereafter. After switch to a TDF-containing regimen, only percent change in TH BMD was significant (−3.2%, p = 0.006). In the regression analyses, switch to a TDF-containing regimen was not associated with long-term change in TBS or BMD.

Conclusion

This is the first study among PWH to evaluate the long-term impact of ART on TBS and BMD. At baseline, approximately 20% of patients had a normal BMD but impaired bone microstructure based upon TBS. For patients with 5 years of exposure to ART, there is a stabilization of TBS and BMD after initial nadir in the first 144 weeks. However, FN BMD, TH BMD, and TBS remained low at 5 years relative to baseline.

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Acknowledgments

We thank the patients and their families for their participation during this study.

Funding

This study was funded by the National Key Technologies Research and Development Program for the 13th Five-Year Plan (2017ZX10202101) and the Chinese Academy of Medical Sciences (CAMS) Innovation Fund for Medical Sciences (2017-12M-1-014). This publication was also made possible by CTSA grant number UL1 TR001863 from the National Center for Advancing Translational Science (NCATS), components of the National Institutes of Health (NIH), and NIH roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH. Dr. Guan is supported by the 2019 Peking Union Medical College Doctoral Student Short-term Visiting Fund. Dr. Hsieh is supported by NIH/Fogarty International Center K01TW009995.

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Authors and Affiliations

  1. Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China

    Wenmin Guan, Wei Yu, Qiang Lin, Zaizhu Zhang, Junping Tian & Ying Xu

  2. Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China

    Wei Pan, Wei Cao, Xiaojing Song, Yanling Li, Taisheng Li & Evelyn Hsieh

  3. Tsinghua University Medical College, Beijing, China

    Taisheng Li

  4. Section of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06511, USA

    Evelyn Hsieh

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  1. Wenmin Guan
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  3. Wei Yu
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Correspondence to Wei Yu or Taisheng Li.

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Wenmin Guan, Wei Pan, Wei Yu, Wei Cao, Qiang Lin, Zaizhu Zhan, Xiaojing Song, Yanling Li, Junping Tian, Ying Xu, Taisheng Li, and Evelyn Hsieh declare that they have no conflict of interest.

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Guan, W., Pan, W., Yu, W. et al. Long-term trabecular bone score and bone mineral density changes in Chinese antiretroviral-treated HIV-infected individuals. Arch Osteoporos 16, 41 (2021). https://doi.org/10.1007/s11657-021-00890-0

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