Prior J, Burdge D, Maan E, Milner R, Hankins C, Klein M, Walmsley S
Medicine/Endocrinology, University of British Columbia, Vancouver, Canada.
Osteoporos Int. 2007 Oct;18(10):1345-53. doi: 10.1007/s00198-007-0428-7. Epub 2007 Jul 31.
This Canadian study of bone health showed that HIV+ women were more likely to have had fragility fractures (OR 1.7) but had BMD values that were not different than women from a national population-based cohort.
Given that 17.5 million women globally are HIV-infected and living longer on anti-retroviral therapy (ART+), it is essential to determine whether they are at risk for osteoporosis as is currently assumed.
Assessment of osteoporosis risk factors and lifetime low-trauma (fragility) fracture history used a common interviewer-administered questionnaire and phantom-adjusted bone mineral density (BMD). This study compared HIV+ Canadian women with age- and region-matched control women (1:3) from a national population-based study of osteoporosis.
One hundred and thirty-eight HIV+ women (100 ART+, 38 ART-) were compared with 402 controls. There were no differences in age (37.7 vs. 38.0 years), BMI (25.0 vs. 26.2), family history of osteoporosis, exercise history, alcohol or calcium intakes, age at menarche, oral contraceptive use or parity. HIV+ cases included more Aboriginal and Black women (12.5% and 16.2 vs. 2% and 1%, respectively), smoked and used injection drugs (53%) more, were more often treated with glucocorticoids, had oligomenorrhea, and reported 10-kg weight cycling. Significantly more HIV+ women reported lifetime fragility fractures (26.1% vs. 17.3; OR 1.7, 95% CI 1.1, 2.6). HIV+ and control women did not differ in BMD: spine 1.0 +/- 0.12 vs.1.0 +/- 0.14 g/cm(2) (diff. 0.0, 95% CI -0.27, 0.27) or total femur 0.91 +/- 0.15 vs. 0.93 +/- 0.12 g/cm(2) (diff 0.02, 95% CI +0.005, -0.045).
HIV+ women reported significantly more past osteoporotic fractures than population-based controls despite normal BMD. Research is needed to assess bone microarchitecture and develop a reliable fracture risk assessment tool for HIV+ women.
这项加拿大的骨骼健康研究表明，感染艾滋病毒的女性更易发生脆性骨折（比值比为1.7），但其骨密度值与全国基于人群的队列研究中的女性并无差异。
鉴于全球有1750万女性感染艾滋病毒并通过抗逆转录病毒疗法（接受抗逆转录病毒治疗者）活得更长，确定她们是否如目前所认为的那样有患骨质疏松症的风险至关重要。
采用常见的由访员实施的问卷以及经体模校正的骨密度来评估骨质疏松症风险因素和终生低创伤（脆性）骨折病史。本研究将加拿大感染艾滋病毒的女性与来自一项全国性基于人群的骨质疏松症研究中年龄和地区匹配的对照女性（1:3）进行了比较。
将138名感染艾滋病毒的女性（100名接受抗逆转录病毒治疗者，38名未接受抗逆转录病毒治疗者）与402名对照者进行了比较。在年龄（37.7岁对38.0岁）、体重指数（25.0对26.2）、骨质疏松症家族史、运动史、酒精或钙摄入量、初潮年龄、口服避孕药使用情况或产次方面均无差异。感染艾滋病毒的病例中包括更多的原住民和黑人女性（分别为12.5%和16.2%，而对照者分别为2%和1%），吸烟和使用注射毒品的比例更高（53%），接受糖皮质激素治疗的频率更高，有月经过少情况，并且报告有10千克的体重波动。报告有终生脆性骨折的感染艾滋病毒的女性明显更多（26.1%对17.3%；比值比为1.7，95%置信区间为1.1至2.6）。感染艾滋病毒的女性和对照女性的骨密度无差异：脊柱骨密度为1.0±0.12克/平方厘米对1.0±0.14克/平方厘米（差异为0.0，95%置信区间为-0.27至0.27），或全股骨骨密度为0.91±0.15克/平方厘米对0.93±0.12克/平方厘米（差异为0.02，95%置信区间为+0.005至-0.045）。
尽管骨密度正常，但感染艾滋病毒的女性报告的既往骨质疏松性骨折明显多于基于人群的对照者。需要开展研究以评估骨微结构，并为感染艾滋病毒的女性开发一种可靠的骨折风险评估工具。
