Arnsten Julia H, Freeman Ruth, Howard Andrea A, Floris-Moore Michelle, Lo Yungtai, Klein Robert S
Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, New York 10467, USA.
AIDS. 2007 Mar 12;21(5):617-23. doi: 10.1097/QAD.0b013e3280148c05.
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.
We analyzed bone mineral density (BMD) and incident fractures in 559 men who were >or= 49 years old with or at-risk for HIV, including 328 with and 231 without HIV infection.
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/cm; P < 0.05) and lumbar spine (1.17 +/- 0.20 versus 1.20 +/- 0.21 g/cm; 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.
HIV infection is independently associated with modestly reduced BMD in aging men, and decreased BMD is associated with increased fracture risk.
骨质疏松症在感染HIV的人群中已有报道，但大多数研究未聚焦于老年男性，未纳入与感染HIV男性风险相似的HIV阴性对照组，或缺乏骨折发生率的数据。
我们分析了559名年龄≥49岁、感染HIV或有感染风险的男性的骨矿物质密度（BMD）和新发骨折情况，其中包括328名感染HIV者和231名未感染HIV者。
中位年龄为55岁，56%为黑人，89%曾使用非法药物。在未经调整的分析中，感染HIV的男性与未感染HIV的男性相比，股骨颈骨密度较低（0.97±0.14对1.00±0.15g/cm；P<0.05），腰椎骨密度也较低（1.17±0.20对1.20±0.21g/cm；P=0.06）；在调整年龄、体重、种族、睾酮水平、泼尼松及非法药物使用情况后，这两个差异均具有统计学意义（P<0.05）。非黑人种族和体重在两个测量部位均与骨密度独立相关，美沙酮治疗与脊柱骨密度独立相关。在感染HIV的男性中，87%曾接受抗逆转录病毒治疗，74%曾接受蛋白酶抑制剂治疗，但它们的使用与骨密度无关。在至少有一次后续研究随访的男性中（94%），骨密度正常、骨量减少和骨质疏松的男性每100人年的新发骨折发生率不同（1.4对3.6对6.5；P<0.01）。感染HIV男性的骨折发生率增加38%，差异无统计学意义。
HIV感染与老年男性骨密度适度降低独立相关，骨密度降低与骨折风险增加相关。
