Bregigeon Sylvie, Galinier Anne, Zaegel-Faucher Olivia, Cano Carla E, Obry Véronique, Laroche Hélène, Trijau Sophie, Saout Armelle, Poizot-Martin Isabelle
aService d'Immuno-hématologie clinique, Aix-Marseille Université, APHM Sainte-Marguerite bINSERM U912 (SESSTIM), Marseille, France.
AIDS. 2017 Jul 17;31(11):1573-1577. doi: 10.1097/QAD.0000000000001507.
The study aims to assess the association between bone mineral density (BMD) and frailty in a cohort of HIV-infected patients.
A cross-sectional study in an HIV outpatient unit where nearly 1000 patients are monitored.
Study participants undergoing bone densitometry were proposed an evaluation of frailty using criteria of the Cardiovascular Health Study (CHS) and the Study of Osteoporotic Fractures (SOF). Frailty markers were weight-loss, self-reported exhaustion, physical activity, grip strength, chair stands, and slow gait. Patients' characteristics were collected from an electronic medical record. Associations of frailty with BMD and osteoporosis were tested using multivariate linear and logit regression models, respectively.
In total, 175 HIV-infected patients, 121 (69.14%) men, were analyzed. Prevalence of frailty markers, osteopenia, and osteoporosis were comparable among sexes. Despite a younger age, spinal and femoral neck BMD were lower in women (P < 0.05). Linear regression model adjusting by age, duration of HIV follow-up, BMI, smoking status, osteoarthritis, osteoporosis treatment, and the age at menopause showed a negative association of spinal and femoral BMD with frailty according to SOF criteria in women (P < 0.05). In men, SOF-defined frailty was associated with osteoporosis (odds ratio 28.79; 95% confidence interval 2.15-386.4) in a model adjusting for age, duration of HIV follow-up, CD4 nadir, CD4 T-cell count, tobacco consumption, exposure to tenofovir (TDF) and protease inhibitors. No significant associations were found between BMD and CHS-defined frailty.
Our study shows that frailty according to SOF criteria is associated with low spinal BMD values in female and osteoporosis in male HIV-infected patients.
本研究旨在评估一组HIV感染患者的骨矿物质密度（BMD）与衰弱之间的关联。
在一个对近1000名患者进行监测的HIV门诊单位开展的横断面研究。
对接受骨密度测定的研究参与者，采用心血管健康研究（CHS）和骨质疏松性骨折研究（SOF）的标准进行衰弱评估。衰弱标志物包括体重减轻、自我报告的疲惫、身体活动、握力、从椅子上站起以及步态缓慢。患者特征从电子病历中收集。分别使用多变量线性回归模型和logit回归模型检验衰弱与BMD及骨质疏松症之间的关联。
共分析了175例HIV感染患者，其中男性121例（69.14%）。衰弱标志物、骨量减少和骨质疏松症的患病率在性别间相当。尽管女性年龄较小，但脊柱和股骨颈的BMD较低（P<0.05）。在根据年龄、HIV随访时间、体重指数、吸烟状况、骨关节炎、骨质疏松症治疗以及绝经年龄进行调整的线性回归模型中，女性脊柱和股骨BMD与SOF标准定义的衰弱呈负相关（P<0.05）。在男性中，在根据年龄、HIV随访时间、CD4最低点、CD4 T细胞计数、烟草消费、替诺福韦（TDF）和蛋白酶抑制剂暴露进行调整的模型中，SOF定义的衰弱与骨质疏松症相关（比值比28.79；95%置信区间2.15 - 386.4）。未发现BMD与CHS定义的衰弱之间存在显著关联。
我们的研究表明，根据SOF标准，衰弱与女性HIV感染患者的低脊柱BMD值以及男性的骨质疏松症相关。
