Alterations in bone turnover in HIV-positive patients.

Infectious Disease Unit, University of Granada Hospital, School of Medicine, University of Granada, Spain.
Infection (Impact Factor: 2.86). 21(4):220-2.
Source: PubMed

ABSTRACT Changes in mineral metabolism have recently been described in AIDS patients. To determine whether such changes affect bone turnover and bone mass, we studied 16 HIV-seropositive patients, classified according to Centers for Disease Control criteria, and 27 healthy controls. Biochemical markers of bone turnover and bone mineral density were analyzed. Serum concentrations of osteocalcin were abnormally low (0.5 +/- 1.3 ng/ml) in HIV-seropositive patients, in comparison with the control group (2.98 +/- 1.6 ng/ml) (p < 0.05). Urinary calcium/creatinine ratio was also decreased in HIV-positive patients (0.10 +/- 0.09 vs 0.14 +/- 0.09) (p < 0.05). In addition, bone mass was slightly lower in HIV-seropositive patients, although the difference was not statistically significant. The pathogenic mechanism of these alterations and their clinical relevance still remain unclear, and several factors may be implicated.

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    ABSTRACT: Concern has been raised that HIV infection, its treatment, or both adversely affect skeletal health. Cross-sectional studies show that bone mineral density (BMD) is 3-5% lower in patients infected with HIV than in uninfected controls, but patients with HIV infection are, on average, 5 kg lighter than uninfected people. After this weight difference is accounted for, BMD differences are smaller and not clinically relevant. Longitudinal studies show short-term BMD loss of 2-4% over 1-2 years when antiretroviral therapy is started, followed by longer periods of BMD increase or stability. Losses are greatest with treatment regimens that contain tenofovir. Patients infected with HIV have slightly higher fracture rates than controls, but the increased risk of fracture is substantially attenuated by adjustment for traditional risk factors for fracture. These reassuring findings suggest that management of skeletal health in HIV should follow guidelines for the general population. In general, effective antiretroviral treatment and avoidance of undernutrition are the two most important factors for maintenance of skeletal health in patients infected with HIV.
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    ABSTRACT: Recently, a high incidence of osteopenia and osteoporosis has been observed in HIV-infected individuals. This problem seems to be more frequent in patients receiving potent antiretroviral therapy, although a specific contribution (if any) of the drugs used in combination regimens has yet to be established. There have also been several reports of other bone-related complications in HIV-infected individuals including avascular necrosis of the hip and compression fracture of the lumbar spine. People living with HIV have significant alterations in bone metabolism regardless of whether or not they are receiving potent antiretroviral therapy. The underlying mechanisms to account for these observations remain unknown, although studies are underway to examine the relationship between the bone abnormalities and other complications associated with HIV and antiretroviral therapy. HIV-infected patients with osteopenia or osteoporosis should be treated similarly to seronegative patients with appropriate use of nutritional supplements (Calcium and Vitamin D) and exercise. Hormone replacement and anti-resorptive therapies might be also indicated.

José Hernández-Quero