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October 3 -7, 2019
San Francisco, CA
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Women With HIV and Prolonged Amenorrhea
Run Higher Risk of Hip Bone Loss

  IDWeek, October 2-6, 2019, Washington, DC
Mark Mascolini
In a group of HIV-positive Canadian women, prolonged amenorrhea (no menstruation for at least 1 year), independently boosted chances of hip bone loss [1]. Prolonged amenorrhea proved twice as likely in women with HIV as in a similar group without HIV.
Researchers from the University of British Columbia noted that both amenorrhea and bone thinning (osteopenia) affect a higher proportion of women with than without HIV infection. Because estrogen plays a critical role in bone health, estrogen deficiency is linked to low bone mineral density (BMD) in the general population [2,3]. The investigators conducted this study because no research addresses the impact of prolonged amenorrhea on bone health in women with HIV.
This cross-sectional cohort-control study involved 19- to 68-year-old women with or without HIV and with similar backgrounds seen at a British Columbia outpatient clinic. Researchers stratified women by prolonged amenorrhea, defined as past or present lack of menses for at least 1 year before age 45 not due to surgery, breastfeeding, pregnancy, or hormonal contraception. They used DXA scans to calculate hip and spine z scores and explored associations between prolonged amenorrhea and BMD with univariate and multivariate models.
The analysis involved 129 women with HIV and 129 without HIV. Average age was similar in the HIV-positive and negative groups (46.3 and 45.1), as was body mass index (26.7 and 27.0). Significantly higher proportions of women with HIV had HCV infection (37% versus 9%, P < 0.001) and used tobacco (40% versus 14%, P < 0.001), while a lower proportion with HIV used alcohol (29% versus 39%, P < 0.001). Among women with HIV, 80% used tenofovir disoproxil fumarate at some point.
In the HIV group, 27 (21%) had prolonged amenorrhea, compared with 12 (9%) in the HIV-negative group (P = 0.01). Compared with HIV-negative controls, women with HIV had significantly lower z scores at the lower hip (-0.4 +/- 0.9 versus 0.3 +/- 1.1, P < 0.001) and spine (-0.5 +/- 1.3 versus 0.2 +/- 1.3, P = 0.001). Multivariable linear regression analysis determined that prolonged amenorrhea in women with HIV independently predicted lower z scores at the hip (P < 0.001) but not at the spine.
Among women with HIV, prolonged amenorrhea proved more frequent in those with HCV (67% versus 29%, P < 0.001), those who used tobacco (67% versus 33%, P < 0.01) or illicit drugs (33% versus 15%, P = 0.05), and those who had any opioid therapy (74% versus 24%, P < 0.001). CD4-count nadir was significantly lower in HIV-positive women with versus without amenorrhea (110 versus 190, P = 0.03).
The researchers concluded that prolonged amenorrhea in women with HIV predicts "significantly and clinically importantly lower BMD in the hip." They proposed that routine menstrual screening of women with HIV may permit early recognition of those at high risk for hip fracture.
1. King E, Nesbitt A, Albert A, et al. Prolonged amenorrhea is associated with decreased hip bone mineral density in women living with HIV. IDWeek, October 2-6, 2019, Washington, DC. Abstract 322.
2. Goshtasebi A, Berger C, Barr SI, et al. Adult premenopausal bone health related to reproductive characteristics-population-based data from the Canadian Multicentre Osteoporosis Study (CaMos). Int J Environ Res Public Health. 2018;15; pii E1023.
3. Ouyang F, Wang X, Arguelles L, et al. Menstrual cycle lengths and bone mineral density: a cross-sectional, population-based study in rural Chinese women ages 30-49 years. Osteoporos Int. 2007;18:221-233.