Background Patients infected with the human immunodeficiency virus (HIV) have a high rate of low bone mineral density (BMD) of multifactorial origin, that involve traditional risk factors, activity of the infection and highly active antiretroviral therapy (HAART). An increased risk of fractures has been reported in these patients but few studies have estimated the true prevalence of asymptomatic morphometric vertebral deformities (MVD).
Objectives To determine the prevalence of MVD in HIV-infected patients followed in a Spanish tertiary center, taking into account both traditional risk factors as those associated with their underlying disease.
Methods We performed a cross-sectional study in HIV-infected patients with age 50 years treated in our center during the period 2014–2015. Demographics and traditional risk factors were collected through a specific survey. BMD was determined by X-ray absorptiometry dual-energy (DXA) at the lumbar spine and hip. Blood and urine samples were collected for biochemical analysis of bone metabolism. WHO definitions were used to classify DXA results. MVD were assessed on lateral X-rays of thoracic and lumbar spine using the Genant's semiquantitative method: 1) reduction of any height of the vertebral body between 20–25%: grade I (mild); 2) between 26–40%: grade II (moderate); and 3) >40%: grade III (severe).
Results A total of 75 patients were included, 54 males (72%), with a mean age of 54.8 years (range: 50–70). MVD was detected in 15 cases (20%): 4 grade I, 6 grade II and 5 grade III. All patients received HAART during the study period. Femoral neck BMD was normal in 39%, 52% were in range of osteopenia and 9% osteoporosis. Variables independently associated with development of MVD were female gender (13% vs 31%, p=0.13), daily calcium intake (490 mg/d vs 594 mg/d, p=0.16), serum phosphorus (2.79 mg/dL vs 3.17 mg/dL, p=0.02) and low BMD in total hip (0.69 vs 0.75, p=0.05) (Table 1). Significant association was also found with disease duration (mean time in patients with MVD: 264.7 months, p=0.09). No correlation was found with age, a fact that can be attributed to limited sample size and age of patients (50–70 years).
Conclusions We found a high prevalence of asymptomatic MVD in our series (20%). X-rays of thoracic and lumbar spine should be performed as a screening method in HIV-infected patients with risk factors, such as long-term infection, low calcium intake, low serum phosphorus levels and female gender.
Disclosure of Interest None declared