Microstructural alterations of trabecular and cortical bone in long-term HIV-infected elderly men on successful antiretroviral therapy

AIDS. 2014 Oct 23;28(16):2417-27. doi: 10.1097/qad.0000000000000445.


Objective: Progress in antiretroviral therapy (ART) has resulted in an almost normal life expectancy for HIV-infected individuals, but an increased risk of fragility fractures has been identified. We investigated the influence of long-term HIV infection on successful ART on bone microstructure in elderly men.

Design: A cross-sectional, case–control study.

Methods: Dual-energy X-ray absorptiometry (DXA) and high-resolution peripheral quantitative computed tomography (HR-pQCT) were performed in 28 HIV-positive men between 60 and 70 years old on successful ART. Controls were 112 HIV-negative men matched for age 4 years and BMI (4 kg/ m²).

Results: HIV-positive men (median CD4þ cell count, 589 cells/ml; BMI, 24.8 kg/m²) had a median duration of HIV infection of 18.2 years. Compared with HIV-negative men, they had a lower DXA-measured areal bone mineral density at total hip (3.2%, P¼0.050) and ultra-distal radius (8.4%, P¼0.001). At distal radius and tibia, we observed microstructural alterations with a lower total density (16%, P¼ 0.005 and 14.3%, P¼ 0.039), trabecular density (11.6%, P¼ 0.012 and 12.2%, P¼ 0.007) and cortical area (17.5%, P¼ 0.002 and 12.2%, P¼ 0.01). In addition, they had a lower trabecular number (P¼ 0.036), higher trabecular spacing (P¼ 0.027) and lower cortical thickness (19.9%; P¼ 0.008) at distal radius. beta-crosslaps (CTX) and vitamin D levels were higher than in controls. By multivariate analyses, HIV status, higher CTX levels, lower physical activity and estradiol levels were determinants of bone density and microstructure alterations.

Conclusion: HIV-infected elderly men on successful ART have trabecular and cortical bone microstructure alterations associated with higher bone resorption, despite adequate vitamin D supplementation.

MeSH terms

  • Absorptiometry, Photon
  • Aged
  • Anti-Retroviral Agents / therapeutic use*
  • Bone Density*
  • Bone and Bones / diagnostic imaging
  • Bone and Bones / physiology*
  • Case-Control Studies
  • Cross-Sectional Studies
  • HIV Infections / drug therapy*
  • Humans
  • Male
  • Middle Aged
  • Tomography, X-Ray Computed


  • Anti-Retroviral Agents