French study further mystifies causes of bone loss in people with HIV
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Antiretroviral treatment has no significant effects on bone mineral density (BMD) in men with HIV, according to French investigators writing in the January 30th edition of AIDS. The study showed that a lower viral load was associated with bone problems, but that it was not linked to the effects of antiretroviral medication.
Osteopenia is a decrease in bone mineral density that can lead to osteoporosis (a thinning and weakening of the bones) and an increased risk of fractures. An increased prevalence of bone problems has been seen in HIV-positive patients, but the reasons behind it are not fully understood.
There have been few studies into the factors that could be associated with bone metabolism, including the use of antiretrovirals, in people living with HIV. The studies that have been conducted show conflicting results. Researchers have struggled to find an over-riding factor leading to bone changes, suggesting that there may be many causes.
In order to estimate the prevalence of reduced bone mineral density and to investigate the factors associated with it, a cross-sectional (or snap-shot) survey within a large cohort of French HIV-positive patients was conducted. The cohort, known as the Aquitaine cohort, is a prospective cohort that includes patients who receive their HIV care at five hospitals in south western France.
Researchers recorded various patient characteristics including gender; age; HIV transmission route (intravenous drug use, homosexual or heterosexual intercourse); date of HIV diagnosis; alcohol and tobacco use; and use of anti-HIV drugs and other medication. All of these variables were extracted from the cohort database and a questionnaire was used at the first clinic visit during the study period to document body mass index, calcium consumption and physical activity. If women were menopausal, this was also recorded due to associations with the menopause and lower bone mineral density.
Bone mineral density was measured for the total body, lumbar spine and femoral neck (close to the hip joint).
Results
A total of 492 patients were included in the investigators
Of these 359 men (73.0%) and 133 women. A total of 31 (23%) women were menopausal. The average age was 43 years and most (93%) were taking antiretroviral therapy. The prevalence of lipodystrophy was 29%.
Osteopenia was diagnosed in 264 patients (54%). When analysed by gender, 55% of men had osteopenia and 51% of women. Osteoporosis was diagnosed in 132 patients (27%), with a prevalence of 3-4% among men and 8% in women. As expected, osteoporosis was seen at higher rates in menopausal women than in premenopausal women (22.6% and 3.9%).
When analysing the data to determine factors linked to bone problems, the investigators looked at men and women separately.
Factors found to be associated with the diagnosis of osteoporosis in men were older age, homosexual HIV transmission, low body mass index and low HIV plasma viral load ( below 500 copies/ml). Only older age and lower body mass index were marginally associated with osteopenia.
In women, all bone disorders were pooled together without the distinction between osteopenia and osteoporosis because there was lower number of diagnoses of each of the subgroups. Only older age and low CD4 cell count nadir (lowest ever recorded) were identified as factors associated with reduced body mass index.
Among these factors found to be associated with low body mass index, some were expected, such as older age or lower body mass index, but others were new, including homosexual HIV transmission group, low HIV viral load and low CD4 cell count nadir.
The researchers speculated that the link with homosexual transmission could indicate that this is a proxy for the use of recreational drugs that might damage the bone metabolism or the presence of coinfections, such as human herpes virus 8.
The finding of an association between lower bone mineral density and lower viral load contradicts some previously published reports whichsuggested that prolonged and high viremia might affect bone formation. In this study, low viral load was the consequence of successful anti-HIV therapy. While this was initially thought to indicate a harmful effect of antiretroviral treatment on bone mineral density of , investigations into the effect of antiretroviral treatment, unadjusted for viral load, did not show significant differences.
The investigators commented,
At 9:03 on March 21, 2005
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Related: French study further mystifies causes of bone loss in people with HIV
Additional information:
From www.aidsmap.com:
The surveys in the figure used different methods to assess calcium consumption, so caution should be used in making comparisons. However, each was designed.
While it is important to get an adequate amount of calcium in your diet, you do not want to go overboard and take excessive.
The differences of diet. The. food. of the low calcium diet. Among animals fed the low calcium diet. the condition occurred. in 17 per.
Calcium, Minerals, Food Sources,Deficiency Symptoms,Recommended.
If you do not get enough calcium in your diet, your body will take the needed calcium from your bones to maintain the calcium supply.
The Stonyfield Farm Diet is high in dairy calcium, high in fiber and. Subjects on a high calcium diet from supplements lost more weight.
Into one control group and one group given a low calcium diet. The animals. were followed for 34 wk. calcium diet, a difference varying.
Think of all of the reasons it is important to have calcium in your diet. A low calcium diet stimulated fat stores and fastened.
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