Low skeletal mass is an important predictor of osteoporosis in HIV-infected men in India

Abstract

Introduction: This study evaluated prevalence and predictors of osteoporosis and sarcopaenia in men with HIV. Methods: A total of 220 men with HIV were screened, of which 115 men, 30-50 years-age, having at least one-year follow-up, underwent hormonal and DEXA analysis. Forty controls were also evaluated. Results: Males with HIV had significantly lower BMD and Z-scores at all sites. Osteoporosis was diagnosed in 64.35%, the commonest site being radius total (49.56%), followed by radius 33% (45.21%), radius ultra distal (36.52%), lumbar spine (19.13%), neck of femur (17.39%), and total femur and greater trochanter (7.82% each). HIV patients had significantly lower fat mass (FM), lean mass (LM), total fat percentage, bone mineral content, gynoid fat, and percentage skeletal muscle mass (PSMM). Men with osteoporosis had higher use of antiretroviral therapy (ART), immune reconstitution inflammatory syndrome (IRIS), tuberculosis, and lower FM, LM, and PSMM. Logistic regression revealed that PSMM, age, and delta (Δ) CD4 count (change in CD4 count after 6-12 months of ART, compared to pre-ART) were the best predictors of osteoporosis. Greater PSMM was associated with decreased osteoporosis, without adjusting for any variable (Model-1), adjusting for disease duration, tuberculosis and IRIS (Model-2), and model-2 plus gonadotropins and sex steroids (Model-3). Greater ΔCD4 count and age were associated with increased osteoporosis after adjusting for different models. Sarcopaenia was observed in 40% of men and in none of the controls. Conclusions: Men with decreased skeletal mass, age, severe immune dysfunction at diagnosis, having rapid increase in CD4 count following ART and IRIS have higher risk of osteoporosis in the long run.