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Changes in bone mineral density over a 2-year period in HIV-1-infected men under combined antiretroviral therapy with osteopenia

Assoumou, Lamberta,b; Katlama, Christinea,b,c; Viard, Jean-Pauld; Bentata, Michellee; Simon, Annef; Roux, Christiang; Kolta, Samig; Costagliola, Dominiquea,b; Rozenberg, Sylviehthe ANRS Osteovir study group

doi: 10.1097/QAD.0b013e32836378c3
Clinical Science: Concise Communication

Objective: Although osteopenia is common in HIV-infected patients, there is by now limited data on the evolution of bone mineral density in this population. We aimed to evaluate the course of osteopenia over a 2-year period in HIV-1-infected men, and to identify risk factors for abnormal bone mineral density (BMD) decline.

Methods: HIV-1-infected men on combined antiretroviral therapy (cART) screened in the ANRS 120 Fosivir trial, diagnosed with low BMD (−2.5 ≤T-score <−1), not receiving antiosteoporotic agents, with sequential dual-energy-X ray-absorptiometry (DXA) available at baseline were eligible for this study and had a second DXA performed between months 24 and 36.

Results: We enrolled 94 men with a median age of 46 years [interquartile range (IQR), 41–53], BMI 22 kg/m2 (21–25) and a CD4+ cell nadir of 164/μl (69–261). They were receiving cART for a median of 7.5 years (5.8–9.5). Over a median interval of 2.6 years (2.3–2.9) between the two DXA tests, the mean change in BMD was −0.5 ± 1.7% per year (P = 0.010) at the lumbar spine and −0.4 ± 1.8% per year (P = 0.033) at the hip. BMD fell by more than the smallest detectable difference (SDD) in, respectively, 25.5 and 27.7% of patients at the lumbar spine and hip. Tenofovir (TDF) exposure was independently associated with a larger decline in BMD at both sites [lumbar spine, OR = 2.4 (1.2–4.9); hip, OR = 2.8 (1.3–5.9)].

Conclusion: Although osteopenia overall modestly changes over 2 years in long-term cART-treated patients, a quarter of patients experienced a significant loss (>1 SDD) associated with TDF exposure.


bUPMC Univ Paris 06, UMRS 943

cAP-HP, Hôpital Pitié-Salpêtrière, Service de Maladies Infectieuses et Tropicales

dAP-HP, Centre de Diagnostic et de Thérapeutique, Hôtel-Dieu, Paris

eAP-HP, Hôpital Avicenne, Service de maladies infectieuses, Bobigny

fAP-HP, Hôpital Pitié-Salpêtrière, Service de médecines internes

gRheumatology Department, Cochin Hospital, Paris-Descartes University

hAP-HP, Hôpital Pitié-Salpêtrière, Service de Rhumatologie and UPMC Univ Paris 06, Paris, France.

Correspondence to Lambert Assoumou, INSERM U943, 56 Bd V Auriol, BP 335, 75625 Paris Cedex 13, France. Tel: +33(0)1 42 16 42 80; fax: +33(0)1 42 16 42 61; e-mail:

Received 19 February, 2013

Revised 17 May, 2013

Accepted 20 May, 2013

These data have been presented in part at the 12th International Workshop on Adverse Drug Reactions and Co-Morbidities in HIV, 4–6 November 2010, London, UK.

© 2013 Lippincott Williams & Wilkins, Inc.