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Decreased bone mineral density and increased fracture risk in aging men with or at risk for HIV infection

Arnsten, Julia Ha,b,c; Freeman, Rutha,d; Howard, Andrea Aa,b; Floris-Moore, Michellea,b; Lo, Yungtaib; Klein, Robert Sa,b

doi: 10.1097/QAD.0b013e3280148c05
Epidemiology and Social

Background: Osteopenia has been described in HIV-infected persons, but most studies have not focused on aging men, have not included an HIV-negative comparison group with similar risks to those of the HIV-infected men, or lacked data on fracture rates.

Methods: We analyzed bone mineral density (BMD) and incident fractures in 559 men who were ≥ 49 years old with or at-risk for HIV, including 328 with and 231 without HIV infection.

Results: Median age was 55 years, 56% were black and 89% had used illicit drugs. In unadjusted analysis, BMD was lower in HIV-infected compared with HIV-uninfected men at the femoral neck (0.97 ± 0.14 versus 1.00 ± 0.15 g/cm2; P < 0.05) and lumbar spine (1.17 ± 0.20 versus 1.20 ± 0.21 g/cm2; P = 0.06); both differences were significant (P < 0.05) after adjusting for age, weight, race, testosterone level, and prednisone and illicit drug use. Non-black race and body weight were independently associated with BMD at both measurement sites and methadone therapy was independently associated with spine BMD. Among HIV-infected men, 87% had taken antiretrovirals and 74% had taken protease inhibitors, but their use was not associated with BMD. Among men who had at least one subsequent study visit (94%), incident fracture rates per 100 person-years differed among men with normal BMD, osteopenia and osteoporosis (1.4 versus 3.6 versus 6.5; P < 0.01). A 38% increase in fracture rate among HIV-infected men was not statistically significant.

Conclusions: HIV infection is independently associated with modestly reduced BMD in aging men, and decreased BMD is associated with increased fracture risk.

From the aDepartments of Medicine, USA.

bEpidemiology & Population Health, USA.

cPsychiatry & Behavioral Sciences, USA.

dObstetrics & Gynecology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, New York, USA.

Received 16 August, 2006

Revised 30 September, 2006

Accepted 23 November, 2006

Correspondence to Julia H. Arnsten, MD, MPH, Montefiore Medical Center, 111 East 210th Street, Bronx, New York, NY 10467, USA. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.