Ó Breasail Mícheál, Madanhire Tafadzwa, Kahari Cynthia, Ebeling Peter R, Simms Victoria, Micklesfield Lisa K, Ferrand Rashida A, Gregson Celia L, Ward Kate A
Department of Medicine, Faculty of Medicine, Nursing and Health Sciences, School of Clinical Sciences, Monash Medical Centre, Monash University, Clayton, Victoria, 3168, Australia.
Population Health Sciences, Bristol Medical School, Bristol BS8 1NU, United Kingdom.
J Bone Miner Res. 2025 Apr 21;40(4):454-462. doi: 10.1093/jbmr/zjaf021.
HIV-related mortality has fallen due to the scale-up of antiretroviral therapy (ART), so more women living with HIV (WLH) now live to reach menopause. Menopausal estrogen loss causes bone loss, as do HIV and certain ART regimens. However, quantitative bone data from WLH are few in Africa. A cross-sectional study of women aged 40-60 yr (49% WLH) was conducted in Harare, Zimbabwe. Menopause status, fracture history, HIV status and treatment, and anthropometry were collected, and radial/tibial peripheral QCT (pQCT) scans were performed. pQCT outcomes were distal radius and tibia trabecular volumetric BMD (vBMD), total area, and compressive bone strength (BSIc); proximal radius and tibia cortical vBMD, BMC, cortical thickness, bone area, and stress-strain index (SSI). Linear regression determined differences by HIV status, minimally adjusted for age and menopause status, and further adjusted for height and fat mass. Relationships between pQCT parameters and major osteoporotic fracture history were explored using univariate logistic regression. In WLH, linear regression assessed associations between HIV and ART durations on pQCT measures. 384 women mean (SD) age 49.7 (5.8) yr had pQCT data. WLH had lower absolute pQCT measures at all sites. Overall, HIV-related deficits were robust to adjustment for age, menopause status, height, and fat mass: WLH had lower trabecular vBMD (radius -7.3 [-12.5; -2.0]%, tibia -5.4 [-9.1; -1.7]%), and cortical vBMD (radius -3.5 [-5.9; -1.1]%, tibia -1.1 [-1.6; -0.5]%). Strength estimates were lower in WLH and of similar magnitude at the radius and tibia. Longer HIV duration was associated with lower radius bone area, BMC, and estimates of bone strength, independent of ART duration. Trabecular deficits predominate in WLH, though with age cortical compartment bone loss may increase in importance. This is particularly concerning as these differences were observed at the radius, a common site of postmenopausal osteoporotic fracture.
由于抗逆转录病毒疗法（ART）的推广，与艾滋病病毒（HIV）相关的死亡率有所下降，因此现在更多感染HIV的女性（WLH）能够活到更年期。绝经后雌激素流失会导致骨质流失，HIV感染及某些ART治疗方案也会导致这种情况。然而，在非洲，关于WLH的定量骨数据很少。在津巴布韦哈拉雷对40至60岁的女性（其中49%为WLH）进行了一项横断面研究。收集了绝经状态、骨折史、HIV感染状况及治疗情况和人体测量数据，并进行了桡骨/胫骨外周定量CT（pQCT）扫描。pQCT的测量结果包括桡骨远端和胫骨小梁骨体积密度（vBMD）、总面积和抗压骨强度（BSIc）；桡骨近端和胫骨皮质vBMD、骨量（BMC）、皮质厚度、骨面积和应力应变指数（SSI）。线性回归确定了按HIV感染状况的差异，对年龄和绝经状态进行了最小程度的校正，并进一步对身高和脂肪量进行了校正。使用单因素逻辑回归探讨了pQCT参数与主要骨质疏松性骨折史之间的关系。在WLH中，线性回归评估了HIV感染持续时间和ART治疗持续时间与pQCT测量值之间的关联。384名平均（标准差）年龄为49.7（5.8）岁的女性有pQCT数据。WLH在所有部位的pQCT绝对测量值都较低。总体而言，在对年龄、绝经状态、身高和脂肪量进行校正后，与HIV相关的骨量不足依然显著：WLH的小梁vBMD较低（桡骨-7.3 [-12.5；-2.0]%，胫骨-5.4 [-9.1；-1.7]%），皮质vBMD也较低（桡骨-3.5 [-5.9；-1.1]%，胫骨-1.1 [-1.6；-0.5]%）。WLH的强度估计值较低，在桡骨和胫骨处的幅度相似。HIV感染持续时间越长，与桡骨骨面积、BMC及骨强度估计值越低相关，且与ART治疗持续时间无关。在WLH中，小梁骨量不足占主导，但随着年龄增长，皮质骨丢失可能会变得更加重要。这尤其令人担忧，因为这些差异在桡骨处被观察到，而桡骨是绝经后骨质疏松性骨折的常见部位。
