Microstructural alterations of trabecular and cortical bone in long-term HIV-infected elderly men on successful antiretroviral therapy

摘要

Objective: Progress in antiretroviral therapy (ART) has resulted in an almost normal life expectancy for HIV-infected individuals, but an increased risk of fragility fractures has been identified. We investigated the influence of long-term HIV infection on successful ART on bone microstructure in elderly men.Design: A cross-sectional, case-control study.Methods: Dual-energy X-ray absorptiometry (DXA) and high-resolution peripheral quantitative computed tomography (HR-pQCT) were performed in 28 HIV-positive men between 60 and 70 years old on successful ART. Controls were 112 HIV-negative men matched for age (±4 years) and BMI (±4kg/m2).Results: HIV-positive men (median CD4+ cell count, 589cells/μl; BMI, 24.8kg/m2) had a median duration of HIV infection of 18.2 years. Compared with HIV-negative men, they had a lower DXA-measured areal bone mineral density at total hip (-3.2%, P = 0.050) and ultra-distal radius (-8.4%, P = 0.001). At distal radius and tibia, we observed microstructural alterations with a lower total density (-16%, P= 0.005 and - 14.3%, P = 0.039), trabecular density (-11.6%, P = 0.012 and -12.2%, P=0.007) and cortical area (-17.5%, P=0.002 and -12.2%, P=0.01). In addition, they had a lower trabecular number (P= 0.036), higher trabecular spacing (P= 0.027) and lower cortical thickness (-19.9%; P= 0.008) at distal radius. beta-crosslaps (CTX) and vitamin D levels were higher than in controls. By multivariate analyses, HIV status, higher CTX levels, lower physical activity and estradiol levels were determinants of bone density and microstructure alterations.Conclusion: HIV-infected elderly men on successful ART have trabecular and cortical bone microstructure alterations associated with higher bone resorption, despite adequate vitamin D supplementation.