Oral Presentation 1st Asia Pacific Herbert Fleisch Workshop 2025

Sex- and compartment-specific deficits in volumetric bone mineral density (vBMD) and estimated bone strength among older people living with HIV (PLWH). (#23)

Mícheál Ó Breasail 1 , Kate A Ward 2 3 , Tadios Manyanga 4 , Hannah Wilson 5 , Camille Pearse 2 , Anya Burton 5 , Lucy Gates 2 , Chris Grundy 6 , Anthony Manyara 5 , Denekew Tenaw Anley 1 , Cynthia Kahari 4 , Tafadzwa Madanhire 5 , Peter R Ebeling 1 , Rashida A Ferrand 4 7 , Celia L Gregson 4 5
  1. Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
  2. MRC Lifecourse Epidemiology Centre , University of Southampton, Southampton, UK
  3. MRC Unit the Gambia at London School for Hygiene and Tropical Medicine, Banjul, The Gambia
  4. The Health Research Unit (THRU), Biomedical Research and Training Institute, Harare, Zimbabwe
  5. Global Musculoskeletal Research Group, Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
  6. MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
  7. Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK

Background: People living with HIV (PLWH) are living longer due antiretroviral therapy (ART). However, chronic-HIV increases the risk of age-associated diseases including osteoporosis. Data suggest HIV-infection and ART exposure increase fracture-risk though quantitative bone data from older PLWH are lacking.

Methods: A cross-sectional study of men and women aged ≥40 years (20.3% PLWH) was conducted in Harare, Zimbabwe.  Sociodemographic data, menopause status, HIV status and treatment, and anthropometry were collected. Outcomes from radial peripheral quantitative computed tomography (pQCT) were: total volumetric bone mineral density (Tt.vBMD), trabecular vBMD (Tb.vBMD), cross-sectional area (CSA 4%), compressive bone strength (BSIc), cortical vBMD (Ct.vBMD), cortical thickness (Ct.Th), CSA 33%, and stress-strain index (SSI).  Sex-stratified linear regression determined differences by HIV status, minimally adjusted for age, wealth index, and menopause status (Model 1), and further adjusted for height and weight (Model 2).  Linear regression assessed associations between HIV and ART durations on bone.

Results: 1101 participants had pQCT data (48.6% male) and were mean(SD) age 62.4 (14.1) years. PWLH were a decade younger, and had lived with HIV for median[IQR] 9.3 [4.8;12.9] years.  HIV-related bone-deficits, robust to full adjustment were observed. Men with HIV had lower radial Tt.BMD, Tb.BMD, and BSIc than HIV-negative men of -7.1 [-10.9;-3.2]%, -11.3 [-16.9;-5.6]%, and -12.0 [-18.7;-5.4]%, respectively (Figure 1.). Trabecular-deficits were comparable in women with HIV, who also had lower Ct.vBMD (-1.4 [-2.3;-0.6]%) and Ct.Th ( -7.2 [-11.1;-3.3]%) than HIV-negative women (Figure 1). In women with HIV, longer HIV duration was associated with lower radius Tt.BMD, Tb.BMD, BSIc and Ct.Th, independent of age and ART. 

Conclusions: Trabecular-deficits predominate in PWLH, though in women cortical-deficits were also evident. This is important as post-menopause, most bone loss is cortical in nature and suggests women with HIV may be at increased risk of age-associated fragility fracture.

 

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