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High prevalence of reduced bone mineral density in primary HIV-1-infected men

Grijsen, Marlous La; Vrouenraets, Saskia MEa,b; Steingrover, Radjina,b; Lips, Paulc; Reiss, Petera,b; Wit, Ferdinand WNMa,b; Prins, Jan Ma

doi: 10.1097/QAD.0b013e32833c93fe
Clinical Science

Objective: To assess the bone mineral density (BMD) in a cohort of men with primary HIV-1 infection (PHI).

Methods: Thirty-three men with PHI had a dual-energy X-ray absorptiometry (DXA) of the lumbar spine, femoral neck and total hip. Osteopenia and osteoporosis were defined according to WHO criteria as T-scores between −1 and −2.5 and −2.5 or less, respectively. The association between clinical and laboratory parameters and BMD was investigated using multivariable linear regression analysis.

Results: Mean age was 38 (SD 9) years and mean body mass index (BMI) 22.7 (SD 3.3) kg/m2. Twenty-four men (73%) had a negative or indeterminate Western blot, 32 men (97%) were combination antiretroviral therapy-naive. Mean plasma HIV-1 RNA was 5.0 (SD 1.2) log10 copies/ml. Mean lumbar spine T (−0.8, SD 1.3, P = 0.001) and Z-scores (−0.7, SD 1.3, P = 0.004) and femoral neck T-score (−0.5, SD 0.9, P = 0.003) were significantly lower compared to the reference population. 15/33 men (45%) had osteopenia and 2/33 (6%) osteoporosis. Markers of bone turnover did not differ between patients with or without osteopenia/osteoporosis. Age was negatively associated with femoral neck (β-coefficient = −0.05, P < 0.001) and total hip T-scores (β = −0.03, P = 0.04). BMI was associated with lumbar spine (β = 0.3), femoral neck (β = 0.2) and total hip (β = 0.2) T-scores (P < 0.001) and thyroid-stimulating hormone (TSH) with lumbar spine (β = 0.5, P = 0.045) and femoral neck T-scores (β = 0.4, P = 0.005). Increased plasma viral load was associated with lower total hip T-scores (β = −0.2, P = 0.02).

Conclusions: Reduced BMD was prevalent in PHI men and was associated with increased age, lower BMI and TSH levels, and higher levels of HIV-1 viremia.

aAcademic Medical Center, University of Amsterdam, Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Center for Infection and Immunity Amsterdam, The Netherlands

bAcademic Medical Center, University of Amsterdam, Center for Poverty-related Communicable Diseases, Amsterdam Institute for Global Health and Development, The Netherlands

cVU University Medical Center, Department of Internal Medicine, Endocrine Section, Amsterdam, The Netherlands.

Received 17 March, 2010

Revised 17 May, 2010

Accepted 27 May, 2010

Correspondence to M.L. Grijsen, MD, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Tel: +31 20 566 4380; fax: +31 20 697 2286; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.