Long-Term Change in Bone Mineral Density in Women Living With HIV: A 10-Year Prospective Controlled Cohort Study.

Women living with HIV (WLWH) may be at higher risk for osteoporosis and fragility fractures. However, limited prospective data describe long-term trajectories of bone mineral density (BMD) in WLWH versus women without HIV. Thus, in this prospective study, we aimed to compare 10-year change in areal BMD (aBMD) between WLWH (n = 49; 36.8 ± 8.8 years; 96% pre/perimenopausal) and HIV-negative women (population-based controls; n = 49; 41.9 ± 9.2 years; 80% pre/perimenopausal). In an exploratory analysis, we compared fracture history between WLWH and controls. Outcomes were lumbar spine (L1 to L4), total hip, and femoral neck aBMD at baseline and follow-up, which occurred at 13 and 10 years in WLWH and controls, respectively. We fit multivariable regression models to compare baseline and 10-year change in aBMD between groups, adjusting for osteoporosis risk factors. Within WLWH, we examined associations between aBMD and HIV-related factors, including combination antiretroviral therapy (cART) duration. WLWH were diagnosed 6.5 ± 3.7 years before baseline, 80% were on cART for 241 ± 142 weeks, and 49% had HIV plasma viral load <40 copies/mL. Before and after adjusting for osteoporosis risk factors, baseline and 10-year change in aBMD did not differ between WLWH and controls at any site. At baseline, more WLWH than controls reported a history of low-trauma fracture (30% versus 10%, p < 0.05) and major osteoporotic fracture (17% versus 4%, p < 0.05). During follow-up, the number of WLWH and controls with incident fragility fracture was not significantly different. Lifetime cART duration and tenofovir use were not associated with aBMD 10-year percent change. Higher CD4 count at baseline was positively associated with femoral neck aBMD 10-year percent change. Long-term aBMD change in this small WLWH cohort paralleled normal aging, with no evidence of influence from cART use; however, these results should be interpreted with caution given the small sample size. Larger cohort studies are needed to confirm these findings. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Changes in bone mineral density may predict the risk of fracture differently in older adults according to fall history.

OBJECTIVES: To determine whether the association between change in bone mass density (BMD) over 4 years and risk of hip and nonvertebral fracture differs according to an individual's history of falls. DESIGN: Population-based cohort study. SETTING: Framingham, Massachusetts. PARTICIPANTS: Individuals with two measures of BMD at the femoral neck (mean age 78.8; 310 male, 492 female). MEASUREMENTS: Cox proportional hazards models were used to estimate hazard ratios (HRs) for the association between percentage change in BMD (per sex-specific standard deviation) and risk of incident hip and nonvertebral fracture. Models were stratified based on history of falls (≥1 falls in the past year) and recurrent falls (≥2 falls) ascertained at the time of the second BMD test. Interactions were tested by including the term "fall history * change in BMD" in the models. RESULTS: Mean change in BMD was -0.6%/year; 27.8% of participants reported falls, and 10.8% reported recurrent falls. Seventy-six incident hip and 175 incident nonvertebral fractures occurred over a median follow-up of 9.0 years. There was no difference in the association between change in BMD and hip fracture according to history of falls (P for interaction = .57). The HR associated with change in BMD and nonvertebral fracture was 1.31 (95% confidence interval (CI) = 1.10-1.56) in participants without a history of falls and 0.95 (95% CI 0.70-1.28) in those with a fall (interaction P = .07). Results for recurrent fallers were similar. CONCLUSION: The effect of BMD loss on risk of nonvertebral fracture may be greater in persons without a history of falls. It is possible that change in BMD contributes less to fracture risk when a strong risk factor for fracture, such as falls, is present.

Effect of Dietary, Biochemical and Other Factors on Bone Mineral Density Change for 2 Years in Korean College Women

This study was conducted to examine whether bone mineral density changes in 55 young Korean college women aged 19 to 26 years over 2 years and nutritional and biochemical factors are related. Bone mineral density (BMD) was measured in the spine (LS), femoral neck (FN), ward's triangle (WT), and femoral trochanter (FT) by dual energy X-ray absorptiometry three times at one-year intervals. Serum osteocalcin (OC), parathyroid hormone (PTH), and urinary cross-linked N-teleopeptides of type collagen (NTx) were measured. Dietary intake was assessed 8 times with 24-hour recall method. Physical activity (PA) was obtained by questionnaire and body fat content was measured by bioelectrical impedance analysis at baseline and after 2 years. Analyses were performed on 34 subjects with all three BMD measurements. The BMDs at the lumbar spine gradually increased over 2 years, while the BMDs of three sites at the femur were sustained or increased. The mean OC, PTH had a similar pattern with the change of BMD at the femur. The mean NTx decreased over 2 years but was still higher than those in other studies. BMI, body fat, vitamin A and zinc intake had a significant correlation with LS-BMD. Femur, PTH, body fat, vitamin A, vitamin B2 and calcium intake had a significant correlation with WT-BMD and was mostly influenced by diet. By multiple regression analysis, it was shown that the significant factors affecting the LS-BMD were BMI and vitamin A intake and those affecting FN and WT were age, BMI, PTH and calcium intake. These results indicate that some Korean women still experience increases in BMD and that this was associated with PTH and vitamin A and calcium intake. Therefore, proper diet and diet management is needed to increase changes in BMD among college women.