The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe.
Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom.
J Bone Miner Res. 2024 Sep 26;39(10):1464-1473. doi: 10.1093/jbmr/zjae138.
Antiretroviral therapy roll-out has dramatically reduced HIV-related mortality; more women are living to reach menopause. Menopausal estrogen loss causes bone loss, as does HIV and some of its treatments. However, data describing HIV's impact on osteoporosis prevalence and fracture risk are scarce in southern Africa. A cross-sectional study of women aged 40-60 years (49% women with HIV [WLH]) was conducted in Harare, Zimbabwe. Menopause, fracture, and HIV history were collected, and anthropometry and BMD (by DXA) measured, and FRAX 10-year fracture probabilities quantified. The FRAX probability of a major osteoporotic fracture (MOF) included HIV as a risk factor for secondary osteoporosis. Linear and Poisson regression determined the relationships between clinical risk factors and both femoral neck (FN) BMD and the 10-year FRAX probability of MOF respectively. The 393 participants had a mean (SD) age of 49.6 (5.8) years and mean (SD) BMI of 29.1 (6.0) kg/m2. 95% of WLH were antiretroviral therapy (ART) established (85% tenofovir disoproxil fumarate) and 81% had a viral load <50 copies/mL. A BMD T-score ≤ -2.5 was more common in WLH than those without, at both FN and lumbar spine (LS) (FN, 22 [11.4%] vs 5 [2.5%]; LS, 40 [20.8%] vs 9 [4.5%], respectively). Prior fracture was more prevalent in WLH: any fracture type (27 [14%] vs 14 [7%]); MOF (14 [7.3%] vs 5 [2.5%]). WLH had a higher 10-year MOF probability (median, 1.2%; IQR, 0.9-1.8) compared with those without HIV (1.0%; IQR, 0.9-1.5) (p < .001), although probabilities were low. Older age, low weight, and HIV infection were strongly associated with lower FN BMD. Higher probability of MOF was associated with older age, HIV infection, parental hip fracture and prior fracture, although adjustment attenuated the association with HIV. No woman reported anti-osteoporosis medication use. While osteoporosis and previous fractures were common and untreated in this relatively young population, particularly in WLH, the FRAX-predicted 10-year MOF risk was low. Clinical risk factors considered in fracture risk prediction tools in Zimbabwe may need contextual modification.
抗逆转录病毒疗法的推出大大降低了与 HIV 相关的死亡率；更多的女性能够活到绝经。绝经后雌激素流失会导致骨质流失，HIV 及其某些治疗方法也是如此。然而，在南部非洲，描述 HIV 对骨质疏松症患病率和骨折风险影响的数据很少。在津巴布韦哈拉雷对 40-60 岁的女性（49%为 HIV 阳性妇女[WLH]）进行了一项横断面研究。收集了绝经、骨折和 HIV 病史，并测量了人体测量学和 BMD（通过 DXA），以及 FRAX 10 年骨折概率。FRAX 主要骨质疏松性骨折（MOF）的概率将 HIV 作为继发性骨质疏松症的危险因素。线性和泊松回归分别确定了临床危险因素与股骨颈（FN）BMD 和 10 年 MOF 的 FRAX 概率之间的关系。393 名参与者的平均（SD）年龄为 49.6（5.8）岁，平均（SD）BMI 为 29.1（6.0）kg/m2。95%的 WLH 接受了抗逆转录病毒治疗（ART）（85%使用替诺福韦二吡呋酯），81%的病毒载量<50 拷贝/mL。FN 和腰椎（LS）的 BMD T 评分≤-2.5 在 WLH 中比无 HIV 者更常见（FN，22 [11.4%] vs 5 [2.5%]；LS，40 [20.8%] vs 9 [4.5%]）。既往骨折在 WLH 中更为常见：任何类型的骨折（27 [14%] vs 14 [7%]）；MOF（14 [7.3%] vs 5 [2.5%]）。与无 HIV 者相比，WLH 的 10 年 MOF 概率更高（中位数，1.2%；IQR，0.9-1.8）（p<0.001），尽管概率较低。年龄较大、体重较低和 HIV 感染与 FN BMD 较低密切相关。较高的 MOF 概率与年龄较大、HIV 感染、父母髋部骨折和既往骨折相关，尽管调整后与 HIV 的关联减弱。没有女性报告使用抗骨质疏松药物。尽管在这个相对年轻的人群中，骨质疏松症和既往骨折很常见且未得到治疗，尤其是在 WLH 中，但 FRAX 预测的 10 年 MOF 风险较低。在津巴布韦，用于预测骨折风险的工具中考虑的临床危险因素可能需要进行背景调整。
