Increased prevalence of asymptomatic vertebral fractures in HIV-infected patients over 50 years of age
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The prevalence of asymptomatic vertebral fracture in HIV-infected patients over 50 was 20%, associated with older age, male sex, longer time since HIV diagnosis, and tubular renal alterations. Vertebral fractures were independent of osteoporosis at lumbar spine, and were not predicted by the use of the FRAX equation.
Vertebral fractures (VF) are the hallmark of osteoporotic fractures. Our objective was to determine the prevalence of asymptomatic VF and associated factors in HIV-infected patients over 50 years, and the role of FRAX equation.
In a cross-sectional study, a diagnosis of VF was established by the semiquantitative method of Genant in thoracic and lumbar radiographs. Simultaneously, a dual X-ray absorptiometry (DXA), bone and kidney-related analytical, calcium intake, physical exercise, HIV-related factors, and FRAX estimation were evaluated.
Overall, 128 patients (35 women, 27%) were included. Mean age was 57 years. Hypophosphatemia and tubular renal dysfunction were observed in 13 and 21%. DXA scan showed osteopenia and osteoporosis at hip in 65 and 7% of patients, and in spine in 39 and 34%, respectively. VF were observed in 26 patients (20%), with a trend to be associated with lower serum phosphate, increased alkaline phosphatase, and with lower daily calcium intake. In a multivariate analysis, older age (OR 1.2 per year; 14% of VF at 50–55; 44% at 65–70), male sex (26 vs 6%), longer time since HIV diagnosis, and renal and tubular dysfunction were the associated factors. VF were not related with osteoporosis at lumbar spine, and could not be predicted by the FRAX equation.
The prevalence of asymptomatic vertebral fractures is high in HIV-infected patients older than 50 years, and is not identified by the presence of osteoporosis in spine neither predicted by the FRAX equation. Spine and lumbar X-rays should be routinely performed in this aging population.
KeywordsVertebral fractures Bone HIV Antiretroviral treatment DXA FRAX equation
We would like to thank Ana Abad for their important contribution in database management.
JLC, MLL, and CM conceived and designed the study and were responsible for patient enrollment, follow-up, and data analysis and drafted and finalized the article; MR conceived and performed analytical evaluations, and WAS, SB, MJPE, MV, and SM were responsible for patient enrollment, clinically followed up patients, and helped to write the work. All coauthors revised the manuscript and approved the final version.
Compliance with ethical standards
Conflicts of interest
- 2.Porcelli T, Gotti D, Cristiano A, Maffezzoni F, Mazziotti G, Focà E, Castelli F, Giustina A, Quiros-Roldan E (2014) Role of bone mineral density in predicting morphometric vertebral fractures in patients with HIV infection. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 25(9):2263–2269CrossRefGoogle Scholar
- 6.Casado JL, Bañon S, Andrés R, Perez-Elías MJ, Moreno A, Moreno S (2014) Prevalence of causes of secondary osteoporosis and contribution to lower bone mineral density in HIV-infected patients. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 25(3):1071–1079CrossRefGoogle Scholar
- 10.Gazzola L, Savoldi A, Bai F, Magenta A, Dziubak M, Pietrogrande L, Tagliabue L, del Sole A, Bini T, Marchetti G, d’Arminio Monforte A (2015) Assessment of radiological vertebral fractures in HIV-infected patients: clinical implications and predictive factors. HIV Med 16(9):563–571CrossRefGoogle Scholar
- 13.Womack JA, Goulet JL, Gibert C, Brandt C, Chang CC, Gulanski B, Fraenkel L, Mattocks K, Rimland D, Rodriguez-Barradas MC, Tate J, Yin MT, Justice AC, for the Veterans Aging Cohort Study Project Team (2011) Increased risk of fragility fractures among HIV infected compared to uninfected male veterans. PLoS One 6(2):e17217CrossRefGoogle Scholar
- 15.Güerri-Fernandez R, Vestergaard P, Carbonell C, Knobel H, Avilés FF, Castro AS, Nogués X, Prieto-Alhambra D, Diez-Perez A (2013) HIV infection is strongly associated with hip fracture risk, independently of age, gender, and comorbidities: a population-based cohort study. J Bone Miner Res 28(6):1259–1263CrossRefGoogle Scholar
- 20.Fink HA, Milavetz DL, Palermo L, Nevitt MC, Cauley JA, Genant HK, Black DM, Ensrud KE, Fracture Intervention Trial Research Group (2005) What proportion of incident radiographic vertebral deformities is clinically diagnosed and vice versa? J Bone Miner Res Off J Am Soc Bone Miner Res 20(7):1216–1222CrossRefGoogle Scholar
- 25.Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. Dietary reference Intakes for calcium and vitamin D [Internet]. Ross AC, Taylor CL, Yaktine AL, Del Valle HB, editors. Washington (DC): National Academies Press (US); 2011 [cited 2017 May 21]. (The National Academies Collection: Reports funded by National Institutes of Health). Available from: http://www.ncbi.nlm.nih.gov/books/NBK56070/
- 28.Yin MT, Shiau S, Rimland D, Gibert CL, Bedimo RJ, Rodriguez-Barradas MC et al (2016) Fracture prediction with modified-FRAX in older HIV-infected and uninfected men. J Acquir Immune Defic Syndr 1999 72(5):513–520Google Scholar
- 29.Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group (2009) KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl (113):S1–S130Google Scholar
- 32.Genant HK, Jergas M, Palermo L, Nevitt M, Valentin RS, Black D et al (1996) Comparison of semiquantitative visual and quantitative morphometric assessment of prevalent and incident vertebral fractures in osteoporosis: the Study of Osteoporotic Fractures Research Group. J Bone Miner Res Off J Am Soc Bone Miner Res 11(7):984–996CrossRefGoogle Scholar
- 37.Pitukcheewanont P, Safani D, Church J, Gilsanz V (2005) Bone measures in HIV-1 infected children and adolescents: disparity between quantitative computed tomography and dual-energy X-ray absorptiometry measurements. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 16(11):1393–1396CrossRefGoogle Scholar
- 39.Sornay-Rendu E, Boutroy S, Munoz F, Delmas PD (2007) Alterations of cortical and trabecular architecture are associated with fractures in postmenopausal women, partially independent of decreased BMD measured by DXA: the OFELY study. J Bone Miner Res Off J Am Soc Bone Miner Res 22(3):425–433CrossRefGoogle Scholar
- 50.Aberg JA, Gallant JE, Ghanem KG, Emmanuel P, Zingman BS, Horberg MA, Infectious Diseases Society of America (2014) Primary care guidelines for the management of persons infected with HIV: 2013 update by the HIV medicine association of the Infectious Diseases Society of America. Clin Infect Dis Off Publ Infect Dis Soc Am 58(1):e1–e34Google Scholar