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Archives of Osteoporosis

, 13:56 | Cite as

Increased prevalence of asymptomatic vertebral fractures in HIV-infected patients over 50 years of age

  • Maria LlopEmail author
  • W. A. Sifuentes
  • S. Bañón
  • C. Macia-Villa
  • M. J. Perez-Elías
  • M. Rosillo
  • S. Moreno
  • M. Vázquez
  • J. L. Casado
Original Article

Abstract

Summary

The prevalence of asymptomatic vertebral fracture in HIV-infected patients over 50 was 20%, associated with older age, male sex, longer time since HIV diagnosis, and tubular renal alterations. Vertebral fractures were independent of osteoporosis at lumbar spine, and were not predicted by the use of the FRAX equation.

Purpose

Vertebral fractures (VF) are the hallmark of osteoporotic fractures. Our objective was to determine the prevalence of asymptomatic VF and associated factors in HIV-infected patients over 50 years, and the role of FRAX equation.

Methods

In a cross-sectional study, a diagnosis of VF was established by the semiquantitative method of Genant in thoracic and lumbar radiographs. Simultaneously, a dual X-ray absorptiometry (DXA), bone and kidney-related analytical, calcium intake, physical exercise, HIV-related factors, and FRAX estimation were evaluated.

Results

Overall, 128 patients (35 women, 27%) were included. Mean age was 57 years. Hypophosphatemia and tubular renal dysfunction were observed in 13 and 21%. DXA scan showed osteopenia and osteoporosis at hip in 65 and 7% of patients, and in spine in 39 and 34%, respectively. VF were observed in 26 patients (20%), with a trend to be associated with lower serum phosphate, increased alkaline phosphatase, and with lower daily calcium intake. In a multivariate analysis, older age (OR 1.2 per year; 14% of VF at 50–55; 44% at 65–70), male sex (26 vs 6%), longer time since HIV diagnosis, and renal and tubular dysfunction were the associated factors. VF were not related with osteoporosis at lumbar spine, and could not be predicted by the FRAX equation.

Conclusions

The prevalence of asymptomatic vertebral fractures is high in HIV-infected patients older than 50 years, and is not identified by the presence of osteoporosis in spine neither predicted by the FRAX equation. Spine and lumbar X-rays should be routinely performed in this aging population.

Keywords

Vertebral fractures Bone HIV Antiretroviral treatment DXA FRAX equation 

Notes

Acknowledgements

We would like to thank Ana Abad for their important contribution in database management.

Author contribution

JLC, MLL, and CM conceived and designed the study and were responsible for patient enrollment, follow-up, and data analysis and drafted and finalized the article; MR conceived and performed analytical evaluations, and WAS, SB, MJPE, MV, and SM were responsible for patient enrollment, clinically followed up patients, and helped to write the work. All coauthors revised the manuscript and approved the final version.

Compliance with ethical standards

Conflicts of interest

None.

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • Maria Llop
    • 1
    Email author
  • W. A. Sifuentes
    • 1
  • S. Bañón
    • 2
  • C. Macia-Villa
    • 3
  • M. J. Perez-Elías
    • 2
  • M. Rosillo
    • 4
  • S. Moreno
    • 2
  • M. Vázquez
    • 1
  • J. L. Casado
    • 2
  1. 1.Department of RheumatologyRamon y Cajal HospitalMadridSpain
  2. 2.Department of Infectious DiseasesRamon y Cajal HospitalMadridSpain
  3. 3.Department of RheumatologySevero Ochoa HospitalMadridSpain
  4. 4.Department of BiochemistryRamon y Cajal HospitalMadridSpain

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