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Longitudinal Analysis of Bone Mineral Density in Aging Men With or at Risk for HIV Infection: heroin causes bone loss; accelerated bone loss progressed over 3 years in HIV+
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Reported by Jules Levin
CROI 2010
Anjali Sharma*1, Peter L. Flom1, Jeremy Weedon1, and Robert S. Klein21SUNY Downstate Medical Center, Brooklyn, New York , USA;2Mount Sinai School of Medicine, New York, New York, USA
from Jules: very important - Of men initially with normal BMD at all sites, 13.7% progressed to osteopenia (n=24/175). Of men initially with osteopenia, 12% (n=19/158) progressed to osteoporosis.
Background: Longitudinal studies of bone mineral density (BMD) in aging HIV+ men, especially drug users, are lacking.
Methods: Men ≥49 years old at-risk for HIV infection underwent standardized semiannual interviews. HIV serology, CD4+ count, HIV viral load, and testosterone levels were measured. BMD was assessed by dual x-ray absorptiometry on study entry and ≥18 months later. Multiple linear regression analysis assessed factors independently associated with change in BMD at the femoral neck, hip and lumbar spine (LS).
Results: Of 389 participants, 230 (59%) were HIV+; 88% reported lifetime use of cocaine or opioids, 64% current smoking, and 49% had serum testosterone levels <300 ng/dL at baseline. Mean age was 55.6 years, mean BMI was 26.6, and 58% were Black, 22% Hispanic, and 14% White.
Initially, 46.1% had normal BMD at all 3 sites, 41.6% had osteopenia, and 12.4% had osteoporosis at ≥ 1 site. HIV+ men had lower BMD (in g/cm2) at the femoral neck, (0.98 vs. 1.02, p= .02), hip (1.01 vs. 1.06, p< .01) and LS (1.15 vs. 1.19, p= .03) compared with HIV-men.
Of men initially with normal BMD at all sites, 13.7% progressed to osteopenia (n=24/175). Osteopenia incidence for HIV-men was 2.6 per 100 person-years at risk [PYAR]) and for HIV+ men 7.2/100-PYAR (p= .02).
Of men initially with osteopenia, 12% (n=19/158) progressed to osteoporosis.
For both HIV-and HIV+ men osteoporosis incidence was 2.2/100-PYAR.
In multivariate analysis of BMD change at the femoral neck, we found a significant interaction between heroin use (within 5 yrs) and AIDS diagnosis, such that the greatest rate of bone loss was seen in persons with both AIDS and heroin use, after adjusting for age, race/ethnicity, BMI, baseline BMD, corticosteroid use, family history of vertebral fracture, and current methadone use.
In this model, hepatitis C virus seropositivity was associated with femoral neck bone loss (p=.04). At the hip, the association of BMD loss with the interaction between AIDS and heroin use remained significant in the multivariable model, as was current methadone use (p<.01).
In multivariate analysis of factors associated with greatest decline in BMD at any of the 3 sites, the interaction between AIDS and heroin use was associated with greater bone loss (p=.04) while current methadone use was borderline (p=.06).
Conclusions: These findings suggest a combined effect of heroin use and AIDS upon bone metabolism. Heroin users with AIDS may be at particular risk for bone loss.
*Multivariate models are adjusted for age, race/ethnicity, baseline BMD, and BMI
Men With Osteopenia at Baseline
Men with Osteoporosis at Baseline
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