Gazzola L, Savoldi A, Bai F, Magenta A, Dziubak M, Pietrogrande L, Tagliabue L, Del Sole A, Bini T, Marchetti G, d'Arminio Monforte A
Department of Health Sciences, Clinic of Infectious Diseases, 'San Paolo' Hospital, University of Milan, Milan, Italy.
Department of Radiology, 'San Paolo' Hospital, University of Milan, Milan, Italy.
HIV Med. 2015 Oct;16(9):563-71. doi: 10.1111/hiv.12267. Epub 2015 May 6.
The aim of this study was to evaluate the clinical impact of including lateral spine X-ray in the screening of bone diseases in HIV-positive patients.
A total of 194 HIV-positive patients underwent dual-energy X-ray absorptiometry (DEXA), lateral spine X-ray and bone biochemical analysis. Vertebral fractures were identified using a morphometric analysis of X-rays and classified using the semiquantitative scoring system of Genant et al. For each patient, a spine deformity index (SDI) score was calculated by summing the grades of vertebral deformities. Reductions in vertebral body height of > 25% were considered vertebral fractures, and those < 25% were considered vertebral deformities. Risk factors associated with vertebral fractures were evaluated by univariate and multivariate analysis.
Vertebral fractures were detected in 24 patients (12.4%) and vertebral deformities in 17 patients (8.7%); 153 patients (78.9%) did not show any vertebral deformity. Among patients with fractures, only two with SDI > 10 reported lumbar pain; the remaining were asymptomatic. Patients over 50 years old showed a higher prevalence of vertebral fracture [24.4% versus 11.8% in patients 41-50 years old (P = 0.05) and 1.9% in patients ≤ 40 years old (P = 0.04)]. No significant increase in the prevalence according to bone mineral density (BMD) reduction was observed, and 70% of fractures were diagnosed in nonosteoporotic patients. Older age [adjusted odds ratio 1.09; 95% confidence interval (CI) 1.03-1.13; P = 0.001] and steroid use (adjusted odds ratio 3.64; 95% CI 1.29-10.3; P = 0.01) were independently associated with vertebral fracture; no association was found with HIV- or highly active antiretroviral therapy (HAART)-related variables.
A prevalence of vertebral fractures of 12.4% was observed in our HIV-positive cohort. Given that two-thirds of fractures occurred in nonosteoporotic patients, spine X-ray may be considered in patients at increased risk, irrespective of BMD; that is, in elderly patients and/or patients using steroids.
本研究旨在评估在HIV阳性患者的骨病筛查中加入脊柱侧位X线检查的临床影响。
共有194例HIV阳性患者接受了双能X线吸收测定法（DEXA）、脊柱侧位X线检查和骨生化分析。通过对X线进行形态学分析来识别椎体骨折，并使用Genant等人的半定量评分系统进行分类。对于每位患者，通过将椎体畸形的等级相加来计算脊柱畸形指数（SDI）评分。椎体高度降低>25%被视为椎体骨折，<25%被视为椎体畸形。通过单因素和多因素分析评估与椎体骨折相关的危险因素。
24例患者（12.4%）检测到椎体骨折，17例患者（8.7%）检测到椎体畸形；153例患者（78.9%）未显示任何椎体畸形。在骨折患者中，只有2例SDI>10的患者报告有腰痛；其余患者无症状。50岁以上患者的椎体骨折患病率较高[41 - 50岁患者为11.8%，与之相比为24.4%（P = 0.05），≤40岁患者为1.9%（P = 0.04）]。未观察到根据骨密度（BMD）降低导致的患病率显著增加，并且70% 的骨折在非骨质疏松患者中被诊断出来。年龄较大[调整后的优势比为1.09；95%置信区间（CI）为1.03 - 1.13；P = 0.001]和使用类固醇（调整后的优势比为3.64；95%CI为1.29 - 10.3；P = 0.01）与椎体骨折独立相关；未发现与HIV或高效抗逆转录病毒治疗（HAART）相关变量存在关联。
在我们的HIV阳性队列中观察到椎体骨折患病率为12.4%。鉴于三分之二的骨折发生在非骨质疏松患者中，对于风险增加的患者，无论其骨密度如何，即老年患者和/或使用类固醇的患者，都可考虑进行脊柱X线检查。
