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Evaluation of bone mineral density, microarchitecture, and detection of fractures on young patients living with human immunodeficiency virus: when and how to screen?

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Abstract

Purpose

People living with the human immunodeficiency virus (PLWH) developed higher life expectancy along with chronic bone disease over the past years. Our purpose is to evaluate bone mineral density, bone microarchitecture and fractures in young PLWH and understand the disease’s contribution to bone derangements and fracture risk.

Methods

Eighty-one HIV-infected and 54 control young (20–50 years) male and female subjects were enrolled in this study. Methods for patient evaluation included DXA-VFA (dual energy X-rays and vertebral fracture assessment), HR-pQCT (high resolution peripheral quantitative computed tomography), biochemistry and FRAX.

Results

Fifty participants from each group completed all exams. Median age was 40 (25–49) vs. 36.5 (22–50) for the HIV and control groups, respectively (p 0.120). Ethnicity, body mass index, serum phosphorus, 25-hydroxyvitamin D, PTH and CTX were similar between groups, although ALP and OC suggested higher bone turnover in PLWH. VFA identified morphometric vertebral fractures in 12% of PLWH. PLWH had lower values for lumbar spine areal BMD and Z score, volumetric BMD, trabecular bone fraction (BV/TV) and trabecular number measured at the distal tibia by HR-pQCT; as a consequence, trabecular separation and heterogeneity were higher (all p < 0.05). The FRAX-estimated risk for hip and major osteoporotic fractures was statistically higher in PLWH (p < 0.001).

Conclusion

Our results confirm severe bone impairment and fractures associated with HIV in young patients. Thus, we developed a screening protocol for young PLWH to detect bone fragility, reduce skeletal disease progression and morbimortality, decrease fracture risk, and increase quality of life.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Programa de Pós-graduação em Fisiopatologia Clínica e Experimental (FISCLINEX) – Universidade Estadual do Rio de Janeiro, Rio de Janeiro, 20551-030, RJ, Brasil

    Bárbara Gehrke & Maria Caroline Alves Coelho

  2. Centro de Pesquisa Clínica Multiusuário (CePeM) – Universidade Estadual do Rio de Janeiro, Rio de Janeiro, 20551-030, RJ, Brasil

    Bárbara Gehrke & Maria Caroline Alves Coelho

  3. Divisão de Endocrinologia, Departamento de Medicina Interna, Faculdade de Ciências Médicas – Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro, 20550-900, RJ, Brasil

    Bárbara Gehrke & Maria Caroline Alves Coelho

  4. Divisão de Endocrinologia – Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, 21941-590, RJ, Brasil

    Maria Lucia Fleiuss Farias, Francisco de Paula Paranhos Neto & Miguel Madeira

  5. Divisão de Neuroendocrinologia - Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, 20231-092, RJ, Brasil

    Luiz Eduardo Wildemberg

  6. Divisão de Infectologia – Hospital Universitário Pedro Ernesto (HUPE)/Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, 20551-030, RJ, Brasil

    Giovanna Ianini Ferraiuoli & Valéria Ribeiro

  7. Labhor – Laboratório de Hormônios da Endocrinologia - Hospital Universitário Pedro Ernesto (HUPE)/Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, 20551-030, RJ, Brasil

    Rogério Bosgnoli

  8. Divisão de Reumatologia, Departamento de Medicina Interna – Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, 21941-590, RJ, Brasil

    Laura Maria Carvalho de Mendonça

Authors
  1. Bárbara Gehrke
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  4. Giovanna Ianini Ferraiuoli
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  8. Laura Maria Carvalho de Mendonça
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  9. Miguel Madeira
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  10. Maria Caroline Alves Coelho
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by B.G., M.L.F.F., L.E.W., G.I.F., V.R., R.B., F.de P.P.N., L.M.C.de M., M.M. and M.C.A.C. The first draft of the manuscript was written by Bárbara Gehrke and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Bárbara Gehrke.

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Written informed consent was obtained from all individual participants included in the study.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee of the Hospital Universitário Pedro Ernesto from Universidade do Estado do Rio de Janeiro and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Gehrke, B., Farias, M.L.F., Wildemberg, L.E. et al. Evaluation of bone mineral density, microarchitecture, and detection of fractures on young patients living with human immunodeficiency virus: when and how to screen?. Endocrine 83, 214–226 (2024). https://doi.org/10.1007/s12020-023-03501-9

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