Investigation of Osteoporosis in Persons Living with Human Immunodeficiency Virus: The HOST Study

TL;DR

This study examines bone health in people with HIV, finding that many have low bone density and differences in bone structure that may increase fracture risk.

Contribution

The study provides new insights into bone microarchitecture differences in PLHIV with varying bone density levels.

Findings

47% of PLHIV had low bone density and 6% had osteoporosis.

HRpQCT showed significant differences in bone microarchitecture between PLHIV with normal, low, and osteoporotic BMD.

Lower BMI was significantly associated with lower BMD in PLHIV.

Abstract

Bone health is an emerging concern in the aging human immunodeficiency virus (HIV)-infected population. We aimed to investigate bone mineral density (BMD) and bone microarchitecture in persons living with HIV (PLHIV). The study was a cross-sectional study. BMD and bone microarchitecture were investigated by Dual-Energy X-ray Absorptiometry (DXA) at the hip and lumbar spine and High-Resolution peripheral Quantitative Computed Tomography (HRpQCT) at the radius and tibia. Information about risk factors for fracture was obtained from a questionnaire. 183 PLHIV were included, 160 (131 males, 29 females) completed the visit. Age range was 30–78 years and the mean time since first HIV-positive serology was 16.5 years. 47% had low bone density and 6% had osteoporosis. The mean T-score by DXA was − 1.2 (standard deviation (SD) ± 1.0), − 0.7 (SD ± 0.9), and − 0.7 (SD ± 1.3) at the femoral neck, total hip and lumbar spine, respectively. We observed no significant difference in BMD by DXA between participants below or above age 50. BMI was significantly lower in PLHIV with lower BMD (p = 0.001, ANOVA). HRpQCT measurements showed significant differences in cortical area, volumetric BMD, and most microarchitecture parameters between PLHIV with BMD in the normal, low, and osteoporotic ranges measured at the tibia and radius. Our results indicate that bone microarchitecture and BMI vary considerably between PLHIV with normal, low, and osteoporotic BMD. These differences may partly explain the increased fracture risk seen in PLHIV.

Trial numbers: Ethics Committee of the Central Denmark Region (case no. 1-10-72-238-17), Danish Data Protection Agency (case no. 1-16-02-708-17).

The online version contains supplementary material available at 10.1007/s00223-025-01368-8.

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