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High prevalence of and progression to low bone mineral density in HIV-infected patients: a longitudinal cohort study

Bonjoch, Annaa; Figueras, Martab; Estany, Carlaa; Perez-Alvarez, Núriaa,b; Rosales, Joaquimc; del Rio, Luísc; di Gregorio, Silvanac; Puig, Jordia; Gómez, Guadalupea,b; Clotet, Bonaventuraa,d; Negredo, Eugèniaathe Osteoporosis Study Group

doi: 10.1097/QAD.0b013e328340a28d
Clinical Science

Background: Low bone mineral density (BMD) is an emerging metabolic condition in HIV-infected patients; however, data on progression of this disease are scarce.

Methods: We studied 671 patients with at least one dual-energy X-ray absorptiometry scan (391 of them ≥2 scans) to determine the prevalence and progression of BMD and establish related factors. Linear regression and logistic polytomic regression were used for the cross-sectional study and mixed effects and generalized estimating equations were used for the longitudinal study.

Results: Osteopenia and osteoporosis were diagnosed in 47.5 and 23%, respectively. Progression to bone demineralization was observed in 28% of the patients over a median of 2.5 years (12.5% progressed to osteopenia and 15.6% to osteoporosis). In the 105 patients with at least 5 years of follow-up, progression was 47% (18% to osteopenia; 29% to osteoporosis). Factors associated with bone loss and progression were age [odds ratio (OR) 1.07; 95% confidence interval (CI) 1.05–1.08; P < 0.0001], male sex (OR 2.23; 95% CI 1.77–2.8; P < 0.0001), low body mass index (OR 1.14; 95% CI 1.11–1.17; P < 0.0001), time on protease inhibitor (OR 1.18; 95% CI 1.12–1.24; P < 0.0001), time on tenofovir (OR 1.08; 95% CI 1.03–1.14; P < 0.0019), and current use of protease inhibitors (OR 1.64; 95% CI 1.35–2.04; P < 0.0001).

Conclusions: Our results show a high prevalence of and considerable progression to osteopenia/osteoporosis in our cohort. Our findings support the importance of applying adequate strategies to prevent bone demineralization and of close monitoring of BMD in HIV-infected patients, specifically in at-risk patients who are taking antiretrovirals that affect bone mineralization.

aLluita contra la SIDA Foundation, University Hospital Germans Trias, Spain

bStatistics and Operations Research, Technical University of Catalunya, Spain

cCETIR Grup Mèdic, Spain

dIrsiCaixa Foundation, Barcelona, Spain.

Received 2 August, 2010

Revised 8 September, 2010

Accepted 13 September, 2010

Correspondence to Anna Bonjoch, MD, PhD, Fundació Lluita contra la SIDA, Hospital Universitari Germans Trias i Pujol, Ctra de Canyet, s/n, 08916 Badalona, Barcelona, Spain. Tel: +34 93 497 88 87; fax: +34 93 465 76 02; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.