Ciullini Lorenzo, Pennica A, Argento G, Novarini D, Teti E, Pugliese G, Aceti A, Conti F G
Infectious Diseases, S. Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy.
Radiology, S. Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy.
J Bone Miner Metab. 2018 Jan;36(1):111-118. doi: 10.1007/s00774-017-0819-6. Epub 2017 Feb 23.
Fragility fractures risk is increased among HIV infected patients. Bone microstructure alterations, in addition to bone mineral density (BMD) reduction, might be responsible for the increased risk. The aim of this study was to determine the prevalence of vertebral fractures (VFs) and their association with trabecular bone score (TBS), an indirect index of bone microstructure, in a cohort of HIV-infected subjects. One-hundred and forty-one HIV-infected patients (87% males, median age 43 years, 94% on stable antiretroviral therapy with undetectable viral load) underwent viro-immunological and bone metabolism biochemical screenings. Lumbar TBS and BMD at femoral neck, total hip, and lumbar spine, were measured with dual-energy X-ray absorptiometry (DXA). VFs were identified using the semiquantitative method and quantitative morphometric analysis from thoracic and lumbar spine X-ray images. VFs were observed in 19 patients (13.5%). BMD was below the expected range for age in 18 (12.8%) subjects. No significant differences were found stratifying VFs prevalence by BMD, whereas patients with lower TBS showed a higher prevalence of VFs (p = 0.03). In multivariate analysis, TBS was the only factor significantly associated to VFs (OR = 0.56; 95% CI = 0.33-0.96; p = 0.034), with increased fracture risk for lower TBS values. VFs are prevalent and associated with low TBS among HIV-positive patients, whereas no significant association was found with BMD.
HIV感染患者发生脆性骨折的风险增加。除骨矿物质密度（BMD）降低外，骨微结构改变可能是导致风险增加的原因。本研究的目的是确定一组HIV感染受试者中椎体骨折（VF）的患病率及其与小梁骨评分（TBS，一种骨微结构的间接指标）的关联。141例HIV感染患者（87%为男性，中位年龄43岁，94%接受稳定的抗逆转录病毒治疗且病毒载量不可检测）接受了病毒免疫学和骨代谢生化筛查。采用双能X线吸收法（DXA）测量股骨颈、全髋和腰椎的腰椎TBS和BMD。使用半定量方法和胸腰椎X线图像的定量形态分析来识别VF。19例患者（13.5%）观察到VF。18例（12.8%）受试者的BMD低于年龄预期范围。按BMD分层的VF患病率未发现显著差异，而TBS较低的患者VF患病率较高（p = 0.03）。在多变量分析中，TBS是与VF显著相关的唯一因素（OR = 0.56；95%CI = 0.33 - 0.96；p = 0.034），TBS值越低骨折风险越高。VF在HIV阳性患者中普遍存在且与低TBS相关，而与BMD未发现显著关联。
