Long-Term Change in Bone Mineral Density in Women Living With HIV: A 10-Year Prospective Controlled Cohort Study

Heather M Macdonald; Evelyn J Maan; Claudie Berger; Hélène C F Côte; Melanie C M Murray; Neora Pick; Jerilynn C Prior; CIHR Team in Cellular Aging and HIV Comorbidities in Women and Children: CARMA

doi:10.1002/jbm4.10761

Long-Term Change in Bone Mineral Density in Women Living With HIV: A 10-Year Prospective Controlled Cohort Study

JBMR Plus. 2023 Jul 5;7(8):e10761. doi: 10.1002/jbm4.10761. eCollection 2023 Aug.

Authors

Affiliations

¹ Active Aging Research Team University of British Columbia Vancouver BC Canada.
² Department of Family Practice Faculty of Medicine, University of British Columbia Vancouver BC Canada.
³ Oak Tree Clinic, BC Women's Hospital and Health Centre Vancouver BC Canada.
⁴ Research Institute of the McGill University Health Centre Montreal QC Canada.
⁵ Department of Pathology & Laboratory Medicine University of British Columbia Vancouver BC Canada.
⁶ Centre for Blood Research Faculty of Medicine, University of British Columbia Vancouver BC Canada.
⁷ Women's Health Research Institute Vancouver BC Canada.
⁸ Department of Medicine, Division of Infectious Diseases University of British Columbia Vancouver BC Canada.
⁹ Centre for Menstrual Cycle and Ovulation Research, Department of Medicine, Division of Endocrinology University of British Columbia Vancouver BC Canada.
¹⁰ School of Population and Public Health Faculty of Medicine, University of British Columbia Vancouver BC Canada.

Abstract

Women living with HIV (WLWH) may be at higher risk for osteoporosis and fragility fractures. However, limited prospective data describe long-term trajectories of bone mineral density (BMD) in WLWH versus women without HIV. Thus, in this prospective study, we aimed to compare 10-year change in areal BMD (aBMD) between WLWH (n = 49; 36.8 ± 8.8 years; 96% pre/perimenopausal) and HIV-negative women (population-based controls; n = 49; 41.9 ± 9.2 years; 80% pre/perimenopausal). In an exploratory analysis, we compared fracture history between WLWH and controls. Outcomes were lumbar spine (L₁ to L₄), total hip, and femoral neck aBMD at baseline and follow-up, which occurred at 13 and 10 years in WLWH and controls, respectively. We fit multivariable regression models to compare baseline and 10-year change in aBMD between groups, adjusting for osteoporosis risk factors. Within WLWH, we examined associations between aBMD and HIV-related factors, including combination antiretroviral therapy (cART) duration. WLWH were diagnosed 6.5 ± 3.7 years before baseline, 80% were on cART for 241 ± 142 weeks, and 49% had HIV plasma viral load <40 copies/mL. Before and after adjusting for osteoporosis risk factors, baseline and 10-year change in aBMD did not differ between WLWH and controls at any site. At baseline, more WLWH than controls reported a history of low-trauma fracture (30% versus 10%, p < 0.05) and major osteoporotic fracture (17% versus 4%, p < 0.05). During follow-up, the number of WLWH and controls with incident fragility fracture was not significantly different. Lifetime cART duration and tenofovir use were not associated with aBMD 10-year percent change. Higher CD4 count at baseline was positively associated with femoral neck aBMD 10-year percent change. Long-term aBMD change in this small WLWH cohort paralleled normal aging, with no evidence of influence from cART use; however, these results should be interpreted with caution given the small sample size. Larger cohort studies are needed to confirm these findings. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Keywords: ANTIRETROVIRAL THERAPY; BONE MINERAL DENSITY CHANGE; CAMOS; HIV; WOMEN.