Journal Article

Assessment of trabecular bone score, an index of bone microarchitecture, in HIV positive and HIV negative persons within the HIV UPBEAT cohort

McGinty, Tara, Macken, Alan, Sheehan, Gerard, Cotter, Aoife G., Kavanagh, Eoin, Sabin, Caroline A., Lambert, John, Mallon, Patrick W. G., Compston, Juliet

2019

Overview

Increased prevalence of low bone mineral density (BMD) and increased fracture incidence are observed in persons living with HIV (PLWH). The trabecular bone score (TBS) is a novel index of bone microarchitecture which improves fracture prediction independent of BMD. The HIV UPBEAT study is a single centre, prospective cohort study that enrolled subjects with and without HIV from similar sociodemographic backgrounds for annual assessments of bone health. TBS was derived from lumbar spine (LS) dual-energy X-ray absorptiometry images. Univariate and multivariable linear regression was used to assess relationships between baseline TBS, BMD, sociodemographic and clinical factors. 463 subjects (201 HIV positive) were included; PLWH were younger and more likely male, of non-African ethnicity and current smokers. HIV was associated with a mean reduction of 0.037 [-0.060, -0.013] (p = 0.002) in TBS. Lower TBS was also associated with male gender, non-African ethnicity, current smoking status and lower LS BMD. HIV remained associated with lower TBS after adjustment for LS BMD, age, gender and ethnicity. However, adjustment for current smoking significantly attenuated the association between HIV and TBS, with further adjustment for higher bone turnover markers largely explaining any residual association. Among the sub-group of PLWH, exposure to protease inhibitors and lower nadir CD4+ T-cell counts were both predictors of lower TBS. PLWH have lower TBS independent of LS BMD. However, this is largely explained by higher current smoking rates and higher bone turnover in those with HIV. Exposure to PI, but not tenofovir disproxil fumarate, also contributed to lower TBS in those with HIV.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Absorptiometry, Photon / Acquired immune deficiency syndrome / Adult / AIDS / Biology and Life Sciences / Bone Density / Bone diseases / Bone mineral density / Bone turnover / Cancellous bone / Cancellous Bone - diagnostic imaging / Care and treatment / CD4 antigen / Cohort Studies / Computer architecture / Drug therapy / Dual energy X-ray absorptiometry / Exposure / Female / Fractures / Fractures (Injuries) / Fractures, Bone - etiology / Health / HIV / HIV Infections - complications / HIV Infections - diagnostic imaging / HIV patients / Hospitals / Human immunodeficiency virus / Humans / Infections / Infectious diseases / Inflammation / Kidney diseases / Lumbar Vertebrae - diagnostic imaging / Lymphocytes T / Male / Medicine / Medicine and Health Sciences / Middle Aged / Minority & ethnic groups / Novels / Osteoporosis / Patients / People and Places / Prospective Studies / Protease inhibitors / Proteases / Proteinase inhibitors / Regression analysis / Research and Analysis Methods / Risk Factors / Smoking / Smoking - adverse effects / Social Sciences / Spine / Spine (lumbar) / T cells / Tenofovir