Santi D, Madeo B, Carli F, Zona S, Brigante G, Vescini F, Guaraldi G, Rochira V
Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via P. Giardini 1355, 41126, Modena, Italy.
Azienda USL of Modena, NOCSAE, Via P. Giardini 1355, 41126, Modena, Italy.
Osteoporos Int. 2016 Mar;27(3):1103-1114. doi: 10.1007/s00198-015-3383-8. Epub 2015 Oct 28.
By investigating the relationship between serum testosterone, estradiol, and bone mineral density (BMD) in a large cohort of HIV-infected men, estradiol was associated with BMD, relative estrogen deficiency being involved in bone loss in men with hypogonadism, in addition to all HIV-related factors. Increased aromatization in adipose tissue does not counteract HIV-related bone loss.
The purpose of this study is to evaluate the relationship between serum testosterone, estradiol, and BMD in a large cohort of HIV-infected men.
We investigated biochemical, hormonal parameters, and BMD in 1204 HIV-infected men (age 45.64 ± 7.33 years) participating in a cross-sectional, observational study. Among other parameters, the main outcome measures were serum total testosterone and estradiol, gonadotropins, 25-hydroxyvitamin D [25(OH)D], parathormone (PTH), calcium, phosphorous, femoral, and lumbar BMD.
In men with HIV, the prevalence of osteoporosis and osteopenia is 15.1 and 63.2% with 25(OH)D insufficiency being very common (60.1%). After age adjustment, BMD is positively associated with estradiol, but not testosterone, at linear (p < 0.001) and stepwise (p < 0.05) multiple regression. Lumbar BMD significantly increases across the estradiol quartiles but not among testosterone quartiles. Femoral and lumbar BMD are significantly higher in men with estradiol ≥ 27 pg/mL than in those with estradiol <27 pg/mL. Apart from estradiol, only age, calcium, and BMI predict BMD at stepwise linear multiple regression, but the strength of this association is weak.
Estradiol, but not testosterone, is associated with BMD in HIV-infected men and exerts a protective role on bone especially when it is above 27 pg/mL. Relative estrogen deficiency is a potential mechanism involved in bone loss in hypogonadal HIV-infected men, in addition to all HIV-related factors. Increased aromatization in adipose tissue does not counteract HIV-related bone loss. Finally, reduced BMD in young-to-middle-aged HIV-infected men might be considered a peculiar hallmark of HIV infection due to its relevant prevalence, representing one of the several pieces composing the complicated puzzle of premature aging related to HIV infection.
通过在一大群感染HIV的男性中研究血清睾酮、雌二醇与骨矿物质密度（BMD）之间的关系，发现雌二醇与BMD相关，除了所有与HIV相关的因素外，相对雌激素缺乏也参与了性腺功能减退男性的骨质流失。脂肪组织中芳香化作用增强并不能抵消与HIV相关的骨质流失。
本研究的目的是评估一大群感染HIV的男性中血清睾酮、雌二醇与BMD之间的关系。
我们调查了1204名参与横断面观察性研究的感染HIV男性（年龄45.64±7.33岁）的生化、激素参数和BMD。在其他参数中，主要结局指标包括血清总睾酮和雌二醇、促性腺激素、25-羟维生素D[25(OH)D]、甲状旁腺激素（PTH）、钙、磷、股骨和腰椎BMD。
在感染HIV的男性中，骨质疏松症和骨质减少的患病率分别为15.1%和63.2%，25(OH)D不足非常常见（60.1%）。年龄调整后，在多元线性回归（p<0.001）和逐步回归（p<0.05）中，BMD与雌二醇呈正相关，与睾酮无关。腰椎BMD在雌二醇四分位数范围内显著增加，但在睾酮四分位数范围内无显著变化。雌二醇≥27 pg/mL的男性的股骨和腰椎BMD显著高于雌二醇<27 pg/mL的男性。在逐步线性多元回归中，除了雌二醇外，只有年龄、钙和BMI可预测BMD，但这种关联的强度较弱。
在感染HIV的男性中，与BMD相关的是雌二醇而非睾酮，尤其是当雌二醇水平高于27 pg/mL时，对骨骼具有保护作用。除了所有与HIV相关的因素外，相对雌激素缺乏是性腺功能减退的感染HIV男性骨质流失的潜在机制。脂肪组织中芳香化作用增强并不能抵消与HIV相关的骨质流失。最后，中青年感染HIV男性的BMD降低可能因其较高的患病率而被视为HIV感染的一个特殊标志，是构成与HIV感染相关的过早衰老这一复杂难题的众多因素之一。
