Vizcarra Pilar, Rosillo Marta, Del Rey José M, Moreno Ana, Vivancos María J, Casado José L
Department of Infectious Diseases, Hospital, Universitario Ramón y Cajal, Cra. Colmenar Km 9.1, 28034, Madrid, Spain.
Department of Biochemistry, Hospital, Universitario Ramón y Cajal, Madrid, Spain.
J Bone Miner Metab. 2022 Nov;40(6):990-997. doi: 10.1007/s00774-022-01365-z. Epub 2022 Aug 29.
In people living with HIV (PLWH), bone mineral density (BMD) discordance between the lumbar spine (LS) and femoral neck (FN) could be frequent given the high frequency of secondary osteoporosis, including HIV-related factors for bone disease.
Retrospective cohort of PLWH with a dual X-ray absorptiometry scan. Hip-spine BMD discordance was defined as different T-score or Z-scores categories at LS and FN.
Overall, 865 individuals (mean 49.5 years, female 27%) were included. Osteoporosis diagnosis was four-to-seven times lower when both skeletal sites were affected than when considering the lowest T-score at any site (overall, 21% vs 4%). Hip-spine BMD discordance was observed in 381 (44%) individuals, it increased with age (from 43 to 52%, P = 0.032), and it was mainly due to lower LS-BMD. A lower FN-BMD was associated with older age, lower BMI (P < 0.01), and HIV-related factors, such as low CD4 + T-cell counts, duration of HIV infection, and time on antiretroviral therapy (ART). In a multivariate regression analysis, sex male (Odds Ratio, OR 4.901), hyperparathyroidism (OR, 2.364), and time on ART (OR 1.005 per month) were independently associated with discordance. A higher estimated fracture risk by FRAX equation was observed in individuals with BMD discordance due to lower FN-BMD compared to those with lower LS-BMD (+ 36% for major osteoporotic fracture, P = 0.04; + 135% for hip fracture, P < 0.01).
Hip-spine BMD discordance is highly prevalent in PLWH and it is associated with classical and HIV-related risk factors, modifying the rate of osteoporosis and fracture risk estimation.
在感染人类免疫缺陷病毒（HIV）的人群（PLWH）中，鉴于继发性骨质疏松症的高发病率，包括与HIV相关的骨病因素，腰椎（LS）和股骨颈（FN）之间的骨矿物质密度（BMD）不一致可能很常见。
对接受双能X线吸收测定扫描的PLWH进行回顾性队列研究。髋部与脊柱BMD不一致定义为LS和FN处的T值或Z值类别不同。
总共纳入了865名个体（平均年龄49.5岁，女性占27%）。当两个骨骼部位均受影响时，骨质疏松症的诊断率比考虑任何部位的最低T值时低四至七倍（总体而言，分别为21%和4%）。在381名（44%）个体中观察到髋部与脊柱BMD不一致，其随年龄增加而增加（从43%增至52%，P = 0.032），且主要是由于LS-BMD较低。较低FN-BMD与年龄较大、体重指数较低（P < 0.01）以及HIV相关因素有关，如CD4 + T细胞计数低、HIV感染持续时间和抗逆转录病毒治疗（ART）时间。在多变量回归分析中：男性（优势比，OR 4.901）、甲状旁腺功能亢进（OR，2.364）和ART治疗时间（每月OR 1.005）与不一致独立相关。与LS-BMD较低的个体相比，由于FN-BMD较低而导致BMD不一致的个体通过FRAX方程估计出的骨折风险更高（主要骨质疏松性骨折增加36%，P = 0.04；髋部骨折增加135%，P < 0.01）。
髋部与脊柱BMD不一致在PLWH中非常普遍，并且与经典和HIV相关的风险因素有关，会改变骨质疏松症的发生率和骨折风险评估。
