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Changes in Bone Mineral Density: two-years follow-up of the ANRS CO3 Aquitaine Cohort - Bone Metabolism Evolves- in 11% from osteopenia to osteoporosis and to osteopenia, bone markers worsen in 41%
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Reported by Jules Levin
CROI 2010
C. Cazanave1,2, S. Lawson-Ayayi1,2,3, N. Barthe1, B. Uwamaliya-Nziyumvira3, A. Kpozehouen3, N. Mehsen1, P. Mercie1,2,3, P. Morlat1,2,3, M. Dupon1,2, F. Dabis1,2,3 for the Groupe d'Epidemiologie Clinique du SIDA en Aquitaine (GECSA)1,3
1Centre Hospitalier Universitaire de Bordeaux; 2Coordination Regionale pour la Lutte contre le Virus de l'Immunodeficience Humaine (COREVIH-Aquitaine); and 3INSERM U897, ISPED, Universite Victor Segalen, Bordeaux, France
AUTHOR CONCLUSIONS
Using accurate follow-up BMD data, we can conclude that bone metabolism is rapidly evolving within 2 years among HIV-infected patients. The overall incidence rate of osteoporosis was 9.57 per 1000 person-years. This longitudinal study confirms the importance of pathological bone loss and the importance of vitamin D deficiency, findings that may lead to preventive interventions...... "Osteoporosis was diagnosed in 29 patients (11.4%) after two years (all of them had osteopenia at baseline)..... 20 patients with normal BMD progressed to the osteopenia stage.....41% of the patients had increased bone resorption markers. Nine cases of moderate phosphate diabetes and 19 of osteomalacia were diagnosed..... bone metabolism is rapidly evolving in 2 years among HIV-infected patients"
Abstract: Longitudinal studies measuring bone mineral density (BMD) are needed to better understand temporal changes of bone abnormalities. We examined the 2-year progression of BMD in a cohort of HIV-infected patients and estimated the incidence of pathological bone loss.
In a previous study we found that the prevalence of BMD osteoporosis was 26.8%. We repeated the BMD assessment 2 years later in a sample of patients who had no bone abnormality or osteopenia diagnosis at baseline.
Bone loss was calculated for each patient and each site by the difference of the 2 BMD measurements; only significant variations, larger than the scanner variation coefficient, were considered. All patients were evaluated by two different methods which allowed to determine a pathological bone loss either by an annual relative change in bone mass superior to physiological data or by a negative difference in Z-scores between Month 24 and Month 0.
Blood and urine tests were also performed to investigate the origin of these deleterious evolutions. 255 patients were recruited, 72 with no bone abnormality and 183 with osteopenia at baseline.
Median age at baseline was 43 years; 67.5% were male; 20.8% patients had reached AIDS stage and all were treated with HAART: 77.3% had a plasma viral load <50 copies/ml and the median CD4 cell count was 569/μl. The median BMI
was 23.1 kg/m2.
Osteoporosis was diagnosed in 29 patients (11.4%) after two years (all of them had osteopenia at baseline). 126 patients had a pathological bone loss (results were the same with the 2 definitions), an incidence of 49.4% (95% Confidence interval: 43.1-55.7%).
The main laboratory abnormality was a deficiency in vitamin D (76.0%); 41% of the patients had increased bone resorption markers. Nine cases of moderate phosphate diabetes and 19 of osteomalacia were diagnosed.
We can conclude that bone metabolism is rapidly evolving in 2 years among HIV-infected patients. This longitudinal study confirms the importance of pathological bone loss and the importance of vitamin D deficiency.
BACKGROUND
Early osteoporosis has been reported in HIV-infected patients, and found to be of
multifactorial origin. Longitudinal studies measuring bone mineral density (BMD) are needed to better understand temporal changes of bone abnormalities.
We examined the 2-year progression of BMD in a cohort of HIV-infected patients and estimated the incidence of pathological bone loss and osteoporosis.
RESULTS
255 patients were recruited, 172 men (67.5%) and 83 women (17 postmenopausal), 72 patients with no bone abnormality and 183 with osteopenia at baseline. Median age was 43.5 years.
The median follow-up since HIV diagnosis was 11.3 years; 20.8% patients had reached the AIDS stage and all were treated with HAART (52.9% with PI). 77.3% had a plasma viral load <50 copies/ml and the median CD4 cell count was 569/μl. The median BMI was 23.1 kg/m2 (Table 1). The median time between the two DEXA tests was 2.3 years.
Osteoporosis was diagnosed in 29 patients (11.4%) after two years (all of them had osteopenia at baseline). 20 patients with normal BMD progressed to the osteopenia stage.
Both genders combined, T-scores decreased on the three measurement sites. This decline was less significant on the total body. Z-scores also decreased, especially on the spine and neck, which is consistent with an abnormal bone loss (Table 2).
The overall incidence rate of osteoporosis was 9.57 per 1000 person-years (P-Y); 95% Confidence interval (CI): 9.56-9.57 per 1000 P-Y. It was 12.05 per 1000 P-Y (95%CI: 9.59- 14.51 per 1000 P-Y) in men, and 4.81 per 1000 P-Y (95%CI: 0.59-9.02 per 1000 P-Y) in women.
126 patients (49.4%) had a pathological bone loss and results were similar using the two definitions.
The overall incidence rate of pathological bone loss was 31.61/100 person-years during the study period.
The main laboratory abnormality was a deficiency in vitamin D (< 30 ng/mL) for 76% of patients (Table 3). 41% of patients had increased bone resorption markers and 25% had reduced osteocalcin. Nine cases of moderate phosphate diabetes and 19 of osteomalacia were also diagnosed.
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