|
8th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIVSan Francisco, California - September 24 - 26, 2006 |
PREVALENCE OF SECONDARY CAUSES OF OSTEOPOROSIS AMONG HIV INFECTED INDIVIDUALS
Antiviral Therapy 2006; 11:Lx (abstract no. 12)
G Guaraldi1, G Orlando1, N Squillace1, V Rochira2, B Madeo2, L Zirilli2, C Diazzi2, G Caffagni2, E Baraldi3, GC Carani2, R Esposito1 and P Tebas4
1Department of Medicine and Medical Specialties, Clinics of Infective Diseases, University of Modena and Reggio Emilia, Modena, Italy; 2Department of Medicine, Endocrinology and Metabolism, Geriatrics, University of Modena and Reggio Emilia, Modena, Italy; 3Laboratory of Endocrinology, Policlinico of Modena, Italy; 4University of Pennsylvania, PA, USA
INTRODUCTION: Patients with HIV infection have a high prevalence of osteopenia/osteoporosis. The frequency of secondary causes of osteoporosis and the extent of the work up needed to exclude them in this population is unknown.
OBJECTIVES: Retrospective study evaluating the frequency of secondary causes of osteoporosis among HIV infected individuals in a large HIV metabolic clinic in Modena, Italy.
METHODS: 1,199 consecutive HIV positive individuals referred for consultation to the metabolic clinic of the University of Modena were induced. The workup included whole body and localized DXA, complete blood count, chemistry profile, serum calcium, PTH, TSH and vitamin D, total and free testosterone for males. DXA and metabolic determinations were done in a single lab. Standard definitions were used for the underlying diagnosis.
RESULTS: The median age was 42. Patients were 62% males, 48% smokers, 68% with low physical activity, 1.2% heavy ETOH users, 42% HCV co-infected and 9% HBsAg (+). Median current and nadir CD4 497 and 159 cells/mm3 respectively. 76% were on ART (45% PI based) and 82% of the treated had HIV RNA <400 copies/ml. 52% and 10% of the patients were osteopenic or osteoporotic in the lumbar spine or the hip according to WHO definitions. The frequency of secondary osteoporosis is summarized in Table 1.
CONCLUSIONS: Although osteopenia/osteoporosis is very frequent among HIV infected individuals, secondary osteoporosis is relatively rare. Vitamin D deficiency (and secondary hyperparthyroidsm associated with it) is frequent in this Italian population and might be a contributor to this problem. The work up for secondary osteoporosis among HIV infected patients should include vitamin D levels, an assessment of renal function and total testosterone determinations. A more extensive work up is rarely useful and it should be reserved for the most severe cases.
| Table 1: (abstract 12) |
|||||
| DXA | n=1199 | Osteoporosis 10% |
Osteopenia 52% |
Normal 36% |
P-value |
|
|
|||||
| Primary hyperparathyroidism | 1,073 | 0% | 0% | 0% | 1 |
| Secondary hyperparathyroidism | |||||
| High PTH, low vitamin D | 723 | 8% | 6.3% | 5.6% | 0.7 |
| High PTH, low GFR* | 1,005 | 3% | 1.3% | 1.1% | 0.3 |
| Hyperthyroidism | 1,072 | 0.9% | 0.7% | 0.3% | 0.56 |
| Vitamin D deficiency | 723 | 46% | 25% | 22% | <0.0001 |
| Hypogonadism (males) | 428 | 5.3% | 8.7% | 11.4% | 0.4 |
| BMI less than 20 kg/m2 | 1,156 | 34% | 20% | 10% | <0.0001 |
|
|
|||||
| *Using MDRD formula | |||||
|
|
|||||
2006-09-24
12
Copyright © 2006 - International Medical Press Ltd. Reproduction of this abstract (other than one copy for personal reference) must be cleared through the Medical Editor, International Medical Press, 36 St Mary-at-Hill, London EC3R 8DU, United Kingdom.