Jeremy Penner, Loice A Ombajo, Joseph Nkuranga, Edwin Otieno, Diana Nyakoe, Ruth Wanjohi, Victor Mbewa, Florentius Ndinya, Sheila Eshiwani, Simon Wahome, Sanjay Bhagani, Anton Pozniak, Celia L Gregson
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Osteoporosis was defined as T-score -2.5 or lower and osteopenia as T-score between -1 and -2.5. Fracture risk was calculated based on clinical risk factors (not including BMD), considering HIV as a secondary cause of osteoporosis, and the correlation between FRAX®-HIV and BMD assessed.</p><p><strong>Results: </strong>Between February and May 2022, a total of 296 participants were enrolled. All were Black African, 147 (49.7%) were female, the median age was 64 years (range 60-77), and 280 (94.6%) were on tenofovir disoproxil fumarate. The median BMD of lumbar spine, total hip, and femoral neck was 0.87 g/cm<sup>2</sup> (interquartile range [IQR] 0.78-0.99), 0.89 g/cm<sup>2</sup> (IQR 0.79-1.01), and 0.75 g/cm<sup>2</sup> (IQR 0.67-0.84), respectively, with median T-scores of -1.9 (IQR -2.8 to -0.7), -1.0 (IQR -1.9 to -0.3), and -1.5 (IQR -2.2 to -0.9), respectively. Osteoporosis and osteopenia were found in 37.5% and 47.3% of participants, respectively. Major osteoporotic fracture and hip fracture 10-year median probabilities using FRAX®-HIV were 3.4% (IQR 2.8-4.6) and 1.0% (IQR 0.7-1.3). Correlation coefficients between these FRAX®-HIV probabilities and femoral neck BMD were -0.204 for major osteoporotic fracture and -0.338 for hip fracture.</p><p><strong>Conclusions: </strong>The prevalence of osteoporosis is high among older people living with HIV in Kenya, where DXA is not readily available and risk calculation without BMD had low correlation with measured BMD values. 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引用次数: 0
摘要
目的我们的目的是评估肯尼亚感染艾滋病毒的老年人在加入临床试验时的骨矿物质密度（BMD）：bictegravir/emtricitabine/tenofovir alafenamide (BFTAF) 老年研究是一项临床试验，研究对象是年龄≥60 岁的病毒已被抑制的 HIV 感染者，他们被随机分配转用 BFTAF 或继续使用入组前的治疗方案。入组时，对腰椎、全髋和股骨颈进行双能 X 射线吸收测定（DXA），并计算 BMD 的 T 值。骨质疏松症的定义是 T 评分-2.5 或更低，骨质疏松症的定义是 T 评分在-1 和-2.5 之间。根据临床风险因素（不包括 BMD）计算骨折风险，将 HIV 视为骨质疏松症的次要原因，并评估 FRAX®-HIV 与 BMD 之间的相关性：2022 年 2 月至 5 月期间，共有 296 人参加了研究。所有参与者均为非洲黑人，147 人（49.7%）为女性，年龄中位数为 64 岁（60-77 岁不等），280 人（94.6%）服用富马酸替诺福韦酯。腰椎、全髋和股骨颈的 BMD 中位数分别为 0.87 g/cm2（四分位距 [IQR] 0.78-0.99）、0.89 g/cm2（IQR 0.79-1.01）和 0.中位 T 值分别为-1.9（IQR -2.8至-0.7）、-1.0（IQR -1.9至-0.3）和-1.5（IQR -2.2至-0.9）。37.5%的参与者患有骨质疏松症，47.3%的参与者患有骨质疏松症。使用FRAX®-HIV的10年主要骨质疏松性骨折和髋部骨折中位概率分别为3.4%（IQR为2.8-4.6）和1.0%（IQR为0.7-1.3）。这些FRAX®-HIV概率与股骨颈BMD之间的相关系数分别为：重大骨质疏松性骨折为-0.204，髋部骨折为-0.338：在肯尼亚，感染艾滋病毒的老年人骨质疏松症发病率很高，而在肯尼亚，DXA 并不容易获得，无 BMD 的风险计算与 BMD 测量值的相关性很低。需要更多数据来说明投资于骨折风险评估和治疗（包括针对特定人群的风险计算器）的影响。
High prevalence of osteoporosis among virally suppressed older people (≥60 years) living with HIV.
Objectives: Our objective was to evaluate bone mineral density (BMD) among older people living with HIV at the time of enrolment into a clinical trial in Kenya.
Methods: The bictegravir/emtricitabine/tenofovir alafenamide (BFTAF) Elderly Study is a clinical trial among virally suppressed people living with HIV aged ≥60 years randomized to switch to BFTAF or continue their pre-enrolment regimen. At enrolment, dual-energy x-ray absorptiometry (DXA) of the lumbar spine, total hip, and femoral neck was performed and T-scores calculated for BMD. Osteoporosis was defined as T-score -2.5 or lower and osteopenia as T-score between -1 and -2.5. Fracture risk was calculated based on clinical risk factors (not including BMD), considering HIV as a secondary cause of osteoporosis, and the correlation between FRAX®-HIV and BMD assessed.
Results: Between February and May 2022, a total of 296 participants were enrolled. All were Black African, 147 (49.7%) were female, the median age was 64 years (range 60-77), and 280 (94.6%) were on tenofovir disoproxil fumarate. The median BMD of lumbar spine, total hip, and femoral neck was 0.87 g/cm2 (interquartile range [IQR] 0.78-0.99), 0.89 g/cm2 (IQR 0.79-1.01), and 0.75 g/cm2 (IQR 0.67-0.84), respectively, with median T-scores of -1.9 (IQR -2.8 to -0.7), -1.0 (IQR -1.9 to -0.3), and -1.5 (IQR -2.2 to -0.9), respectively. Osteoporosis and osteopenia were found in 37.5% and 47.3% of participants, respectively. Major osteoporotic fracture and hip fracture 10-year median probabilities using FRAX®-HIV were 3.4% (IQR 2.8-4.6) and 1.0% (IQR 0.7-1.3). Correlation coefficients between these FRAX®-HIV probabilities and femoral neck BMD were -0.204 for major osteoporotic fracture and -0.338 for hip fracture.
Conclusions: The prevalence of osteoporosis is high among older people living with HIV in Kenya, where DXA is not readily available and risk calculation without BMD had low correlation with measured BMD values. Additional data are required on the impact of investment in fracture risk assessment and treatment, including population-specific risk calculators.
期刊介绍：
HIV Medicine aims to provide an alternative outlet for publication of international research papers in the field of HIV Medicine, embracing clinical, pharmocological, epidemiological, ethical, preclinical and in vitro studies. In addition, the journal will commission reviews and other feature articles. It will focus on evidence-based medicine as the mainstay of successful management of HIV and AIDS. The journal is specifically aimed at researchers and clinicians with responsibility for treating HIV seropositive patients.
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