Session: SAT 248-267-Osteoporosis II
Poster Board SAT-262
Methods: This prospective, cross-sectional study recruited 64 male volunteers with HIV who were virologically suppressed on highly active anti-retroviral therapy (HAART) and 34 non-infected controls. Subjects with known osteoporosis or CKD stage 3 or worse were excluded. Subjects underwent BMD testing by DXA scan and measurement of fasting serum receptor activator of nuclear factor kappa-B ligand (RANKL) and osteoprotegerin (OPG), gonadal hormones, serum insulin-like growth factor-1 (IGF-1), IGF-binding protein 3 (IGFBP-3), and the bone turnover markers (BTM) serum C-telopeptide (CTX), osteocalcin (OC), and bone-specific alkaline phosphatase (BSAP).
Results: The HIV group was slightly older (57 vs. 52 years, p=0.017). BMI was in the overweight range but lower in the HIV group (27.5 vs. 29.8 Kg/m2, p=0.039). At the time of evaluation, 83% of HIV-infected patients were on tenofovir and 48% on protease inhibitors. After adjusting for age, race and BMI, the HIV group had significantly lower femoral neck and total hip BMD, Z-score and T-score (p<0.05 for all). Compared to controls, the HIV group exhibited significantly higher serum CTX (0.58±0.29 vs. 0.41±0.15 ng/mL), OC (21.5±8.9 vs. 15.5±5.1 ng/ml), BSAP (34.2±11.5 vs. 26.4±9.1 U/L) and OPG (4.4±1.4 vs. 3.8±1.0 pM), and lower serum RANKL/OPG ratio (34±31 vs. 54±35) (p<0.05 for all). HIV and Controls had similar serum total testosterone (4.1±2.1 vs. 3.9±1.1 nM), estradiol (35±11 vs. 37±11 pg/mL), LH (5.9±3.7 vs. 5.4±1.7 IU/L), IGF-1 (147±45 vs. 141±41 ng/ml), and IGFBP-3 (3.4±1.1 vs. 3.4±0.6 mg/L) (p>0.3 for all). Within the HIV-infected population, femoral neck BMD was negatively associated with BTM (r= -0.30 for BSAP, r= -0.25 for OC), but not with gonadal hormones or IGF-1.There was a tendency towards lower BMD in tenofovir users (p=0.03-0.09 depending on site), but no difference in BMD between protease inhibitor users and non-users.
Conclusions: HIV-infected men on HAART exhibit significantly lower BMD than non-HIV infected men. The lower BMD persists after adjustment for age, race and BMI, is not explained by changes in serum IGF-1 or gonadal hormones, and is associated with higher bone turnover markers but lower RANKL/OPG ratio.
Nothing to Disclose: NMM, HD, JBC, SZ, RB
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