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Time of Progression to Osteopenia/Osteoporosis in Chronically HIV-Infected Patients: Screening DXA Scan  [PDF]
Eugenia Negredo, Anna Bonjoch, Moisés Gómez-Mateu, Carla Estany, Jordi Puig, Nuria Perez-Alvarez, Joaquin Rosales, Silvana di Gregorio, Luis del Rio, Guadalupe Gómez, Bonaventura Clotet
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0046031
Abstract: Background Algorithms for bone mineral density (BMD) management in HIV-infected patients are lacking. Our objective was to assess how often a dual-energy x-ray absorptiometry (DXA) scan should be performed by assessing time of progression to osteopenia/osteoporosis. Methods All DXA scans performed between 2000 and 2009 from HIV-infected patients with at least two DXA were included. Time to an event (osteopenia and osteoporosis) was assessed using the Kaplan–Meier method. Strata (tertiles) were defined using baseline minimum T scores. Differences between strata in time to an event were compared with the log-rank test. Results Of 391 patients (1,639 DXAs), 49.6% had osteopenia and 21.7% osteoporosis at their first DXA scan. Of the 112 (28.6%) with normal BMD, 35.7% progressed to osteopenia; median progression time was 6.7 years. These patients were stratified: “low-risk" (baseline minimum T score >?0.2 SD), “middle-risk" (between ?0.2 and ?0.6 SD), and “high-risk" (from ?0.6 to ?1 SD); median progression time to osteopenia was 8.7, >7.2, and 1.7 years, respectively (p<0.0001). Of patients with osteopenia, 23.7% progressed to osteoporosis; median progression time was >8.5 years. Progression time was >8.2 years in “low-risk" tertile (T score between ?1.1 and ?1.6 SD), >8.5 years in “middle-risk" (between ?1.6 and ?2), and 3.2 years in “high-risk" (from ?2 to ?2.4) (p<0.0001). Conclusions Our results may help to define the BMD testing interval. The lowest T score tertiles would suggest recommending a subsequent DXA in 1–2 years; in the highest tertiles, ≥6 years. Early intervention in patients with bone demineralization could reduce fracture–related morbidity/mortality.
An Increased Risk of Osteoporosis during Acquired Immunodeficiency Syndrome
Annapoorna N.,Rao G.Venkateswara,Reddy N.S.,Rambabu P.
International Journal of Medical Sciences , 2004,
Abstract: Osteoporosis is characterized by decreased bone mineral density and mechanistic imbalances of bone tissue that may result in reduced skeletal strength and an enhanced susceptibility to fractures. Osteoporosis in its most common form affects the elderly (both sexes) and all racial groups of human beings. Multiple environmental risk factors like acquired immune deficiency syndrome (AIDS) are believed to be one of the causes of osteoporosis. Recently a high incidence of osteoporosis has been observed in human immunodeficiency virus (HIV) infected individuals. The etiology of this occurrence in HIV infections is controversial. This problem seems to be more frequent in patients receiving potent antiretroviral therapy. In AIDS, the main suggested risk factors for the development of osteoporosis are use of protease inhibitors, longer duration of HIV infection, lower body weight before antiretroviral therapy, high viral load. Variations in serum parameters like osteocalcin, c-telopeptide, levels of elements like Calcium, Magnesium, Phosphorus, concentration of vitamin-D metabolites, lactate levels, bicarbonate concentrations, amount of alkaline phosphatase are demonstrated in the course of development of osteoporosis. OPG/RANKL/RANK system is final mediator of bone remodeling. Bone mineral density (BMD) test is of added value to assess the risk of osteoporosis in patients infected with AIDS. The biochemical markers also aid in this assessment. Clinical management mostly follows the lines of treatment of osteoporosis and osteopenia.
Hip Structural Changes and Fracture Risk in Osteopenia and Osteoporosis  [cached]
Meltem Esenyel,Aynur Ozen,Cem Zeki Esenyel,Aylin Rezvani
Eurasian Journal of Medicine , 2011,
Abstract: Objective: Although bone mineral density (BMD) is an important predictor of hip fracture, there is a large overlap of BMD values between those who fracture their hips and those who do not. The aim of this study was to evaluate differences in the structural parameters of the hip in patients with osteopenia and osteoporosis in the hip region and to assess their relationship with osteoporotic fracture risk, age and gender.Materials and Methods: In this observational retrospective study, 150 patients with osteopenia (100 postmenopausal women and 50 men ≥ 50 years of age) and 125 patients with osteoporosis in the hip (100 postmenopaussal women and 25 men ≥ 50 years of age) were included. In addition to densitometry measurements by DEXA (Dual Energy X-ray Absorbimetry), structural variables were determined using the Hip Strength Analysis program (HSA). Results: In logistic regression analyses, the femoral neck BMD (odds ratio (OR), 2.6; 95% Confidence Interval (CI) 1.8-3.8), age (OR per 10 years 1.4; 95% CI, 1.1-1.9), femoral neck shaft angle (NSA) (OR 1.5; 95% CI, 1.2-2.1), Femur Strength Index (FSI) (OR 1.6; 95% CI 1.3-2.2), and Cross sectional area (CSA) (OR 1.6; 95% CI 1.2-2.1) were all associated with osteoporotic fractures in women and men. Osteopenic patients had smaller femoral neck-shaft angles (NSA) compared to osteoporotic patients (p<0.05). This angle was larger in women (p<0.05); and women had decreased (FSI) (p<0.001) and CSA (p<0.05), which cause increased fracture risk. Conclusion: Spatial distribution of bone tissue is a useful determinant of fracture risk.
Osteopenia and osteoporosis in people living with HIV: multiprofessional approach
Lima AL, Oliveira PR, Plapler PG, Marcolino FM, Meirelles ES, Sugawara A, Gobbi RG, Godoy-Santos AL, Camanho GL
HIV/AIDS - Research and Palliative Care , 2011, DOI: http://dx.doi.org/10.2147/HIV.S6617
Abstract: teopenia and osteoporosis in people living with HIV: multiprofessional approach Review (3156) Total Article Views Authors: Lima AL, Oliveira PR, Plapler PG, Marcolino FM, Meirelles ES, Sugawara A, Gobbi RG, Godoy-Santos AL, Camanho GL Published Date December 2011 Volume 2011:3 Pages 117 - 124 DOI: http://dx.doi.org/10.2147/HIV.S6617 Ana Lucia Lei Munhoz Lima, Priscila Rosalba D de Oliveira, Perola Grimberg Plapler, Flora Maria D Andrea Marcolino, Eduardo de Souza Meirelles, André Sugawara, Riccardo Gomes Gobbi, Alexandre Leme Godoy dos Santos , Gilberto Luis Camanho Institute of Orthopedics and Traumatology, Hospital das Clínicas, University of S o Paulo School of Medicine, S o Paulo, Brazil Abstract: Increasing bone mineralization abnormalities observed among people living with HIV (PLWHIV) result from various factors relating to the host, the virus, and the antiretrovirals used. Today, HIV infection is considered to be a risk factor for bone mineralization disorders. The test most recommended for diagnosing osteoporosis is measurement of bone mineral density by means of dual energy X-ray absorptiometry at two sites. Osteoporosis treatment has the aims of bone mass improvement and fracture control. A combination of calcium and vitamin D supplementation may reduce the risk of fractures. Antiresorptive drugs act by blocking osteoclastic activity and reducing bone remodeling. On the other hand, bone-forming drugs stimulate osteoblastogenesis, thereby stimulating the formation of bone matrix. Mixed-action medications are those that are capable of both stimulating bone formation and inhibiting reabsorption. Antiresorptive drugs form the group of medications with the greatest quantity of scientific evidence confirming their efficacy in osteoporosis treatment. Physical activity is a health promotion strategy for the general population, but only preliminary data on its real value and benefit among PLWHIV are available, especially in relation to osteoporosis.
Osteopenia and osteoporosis in people living with HIV: multiprofessional approach  [cached]
Lima AL,Oliveira PR,Plapler PG,Marcolino FM
HIV/AIDS - Research and Palliative Care , 2011,
Abstract: Ana Lucia Lei Munhoz Lima, Priscila Rosalba D de Oliveira, Perola Grimberg Plapler, Flora Maria D Andrea Marcolino, Eduardo de Souza Meirelles, André Sugawara, Riccardo Gomes Gobbi, Alexandre Leme Godoy dos Santos , Gilberto Luis CamanhoInstitute of Orthopedics and Traumatology, Hospital das Clínicas, University of S o Paulo School of Medicine, S o Paulo, BrazilAbstract: Increasing bone mineralization abnormalities observed among people living with HIV (PLWHIV) result from various factors relating to the host, the virus, and the antiretrovirals used. Today, HIV infection is considered to be a risk factor for bone mineralization disorders. The test most recommended for diagnosing osteoporosis is measurement of bone mineral density by means of dual energy X-ray absorptiometry at two sites. Osteoporosis treatment has the aims of bone mass improvement and fracture control. A combination of calcium and vitamin D supplementation may reduce the risk of fractures. Antiresorptive drugs act by blocking osteoclastic activity and reducing bone remodeling. On the other hand, bone-forming drugs stimulate osteoblastogenesis, thereby stimulating the formation of bone matrix. Mixed-action medications are those that are capable of both stimulating bone formation and inhibiting reabsorption. Antiresorptive drugs form the group of medications with the greatest quantity of scientific evidence confirming their efficacy in osteoporosis treatment. Physical activity is a health promotion strategy for the general population, but only preliminary data on its real value and benefit among PLWHIV are available, especially in relation to osteoporosis.Keywords: osteoporosis, HIV/AIDS, diagnosis, treatment, exercise
Factors associated with treatment of women with osteoporosis or osteopenia from a national survey
Eric S Meadows, Beth D Mitchell, Susan C Bolge, Joseph A Johnston, Nananda F Col
BMC Women's Health , 2012, DOI: 10.1186/1472-6874-12-1
Abstract: This retrospective analysis of the United States 2007 National Health and Wellness Survey included women age ≥ 40 years who reported having a diagnosis of osteoporosis (69% of 3276) or osteopenia (31% of 3276). Patients were stratified by whether they were or were not taking prescription treatment for osteoporosis/osteopenia. Using 34 patient characteristics as covariates, logistic regression was used to determine factors associated with treatment.Current prescription treatment was reported by 1800 of 3276 (54.9%) women with osteoporosis/osteopenia. The following factors were associated with receiving prescription treatment: patient-reported diagnosis of osteoporosis (versus osteopenia); previous bone mineral density test; ≥ 2 fractures since age 50; older age; lower body mass index; better physical functioning; postmenopausal status; family history of osteoporosis; fewer comorbidities; prescription insurance coverage; higher total prescription count; higher ratio of prescription costs to monthly income; higher income; single status; previous visit to a rheumatologist or gynecologist; and 1 or 2 outpatient visits to healthcare provider (vs. none) in the prior 6 months. Glucocorticoid, tobacco, and daily alcohol use were risk factors for fracture that were not associated with treatment.There is a mismatch between those women who could benefit from treatment for osteoporosis and those who are actually treated. For example, self-reported use of glucocorticoids, tobacco, and alcohol were not associated with prescription treatment of osteoporosis. Other clinical and socioeconomic factors were associated with treatment (e.g. prescription drug coverage and higher income) or not (e.g. comorbid osteoarthritis and anxiety) and could be opportunities to improve care.Osteoporosis is a systemic skeletal disorder characterized by low bone mass, structural deterioration of bone tissue, and an increased vulnerability to low-trauma fractures [1,2]. In the United States (US), an esti
Bone mineral density in human immunodeficiency virus-1 infected men with hypogonadism prior to highly-active-antiretroviral-therapy (HAART)
J Teichmann, U Lange, T Discher, J Lohmeyer, H Stracke, RG Bretzel
European Journal of Medical Research , 2009, DOI: 10.1186/2047-783x-14-2-59
Abstract: Alterations of bone metabolism have been observed in numerous studies of small groups of male patients infected with HIV. Both hypocalcemic [1,2] or hypercalcemic phases [3-6] reduced serum osteocalcin levels [7-9] and hypoparathyroidism [5,7,9] have been reported. The reduction of bone mineral density (BMD) has been observed in several studies of HIV-afflicted patients [10-13]. Testosterone deficiency is a risk factor for osteoporosis in male and female patients [14-16]. Sex hormone deficiency is among the most frequent endocrine abnormalities in HIV-1 infected men, and it's clinical symptoms (impotence and decreased libido) have been reported in 33 and 67%, respectively [17]. Based on the theory that sex hormone deficiency is mediated through direct osteoblastic and osteoclastic effects, modulation of cytokine milieu, and extraskeletal effects on calcium homeostasis [2], we performed a cross sectional study of 80 HIV-1 infected male subjects, in whom we assessed both biochemical markers of bone metabolism and BMD by dual-energy X-ray absorptiometry (DEXA). Thus, the aim of this investigation was to examine the prevalence of hypogonadism in the HIV-infected outpatients, and to determine the alterations of bone metabolism in HIV-infected patients with hypogonadism compared to those with eugonadism and the manifestation of osteopenia in these patients.80 male patients with a recently confirmed serodiagnosis (including Western blot analysis) of HIV-1 infection participated in the study. They were examined in our outpatient clinic (age range 23 to 45 years). At the time of examination the patients had no concomitant opportunistic infections; no acute or chronic hepatitis with increased liver transaminase activities; nor alterations of the liver parenchyma under sonomorphological criteria; no wasting symptoms; no gastrointestinal disorders such as pancreatic insufficiency or malabsorption syndrome nor chronic diarrhea. The patients did not take any drugs known to influe
Evaluation of periodontal condition of menopause women with osteoporosis and osteopenia and comparison with control group
Khorsand A.,Paknejad M.,Vakili F.
Journal of Dental Medicine , 2006,
Abstract: Background and Aim: Several risk factors directly affect the development of periodontal diseases. Also some systemic diseases act indirectly as predisposing and aggrevating factors. Osteoporosis is one of these factors and one of its main causes is lack of physical activity in postmenopause period. The incidence of osteoporosis is increasing in our country. The goal of this study was to evaluate the periodontal condition of women with osteoporosis and osteopenia referred to bone densitometric division of Loghman hospital in 2003 and compare to control group. Materials and Methods: In this case control study based on BMD (Bone Mineral Density) measurement of back and thigh using DEXA method, 60 patients referred to bone densitometric division of Loghman hospital, were randomly selected. Cases were divided into three groups, 20 with osteoporosis, 20 with osteopenia and 20 normal cases. Periodontal indices consisting of plaque index (PI), tooth loss (TL), gingival recession (GR), probing pocket depth (PPD) and papilla bleeding index (PBI) were evaluated by clinical and radiographic examination. Data were analyzed by Kruskall Wallis and Dunn tests with p<0.05 as the limit of significance. Results: PBI, PI and TL were significantly higher in osteoporotic group than osteopenic and normal group. PPD was not different in the three groups. Due to the low prevalence of recession in our study, this parameter was not included in the statistical analysis. Conclusion: It seems that osteoporosis does not increase the incidence of periodontal diseases because it affects bone quality rather than quantity. In osteoporosis calcium deficiency and increasing age lead to decreased physical activity and ultimately affect the patient's oral hygiene performance. Thus, periodontal manifestations are presented as gingival bleeding and gingivitis.
Quantitative Computerized Tomography (QCT) versus Dual X-Ray Absorptiometry (DXA) in the Assessment of Bone Mineral Density of HIV-1 Infected Children  [PDF]
Joann Lin, Maria Ines Boechat, Jaime G. Deville, Diego Gilsanz, Richard Stiehm, Vicente Gilsanz, Isidro Salusky, Karin Nielsen-Saines
World Journal of AIDS (WJA) , 2012, DOI: 10.4236/wja.2012.24041
Abstract: Bone studies of HIV-infected children using dual X-ray absorptiometry (DXA) suggest bone mineral density (BMD) abnormalities. Pediatric studies are often performed using DXA instead of computed tomography (CT), which accounts for 3-dimensional differences in bone size of growing children. We evaluated whether CT would match DXA measurements in this population. For this purpose, the BMD of 16 perinatally HIV-infected patients, ages 6 to 22 was assessed. Subjects were matched by age, gender, and race to controls. BMD was assessed via DXA and QCT. Clinical anthropometric data, body mass index, immunologic and virologic parameters and laboratory markers for osteoblastic and osteoclastic activity were performed. No statistically significant differences in age and anthropometric parameters between subjects and controls were found. Individual CT and DXA z-scores were significantly different when subjects were evaluated as a group (p = 0.0002) or when males and females were analyzed independently (p = 0.001 and 0.03). DXA z-scores were below 1 SD, while CT z-scores were above the mean. 31% of subjects were identified as having poor bone mineralization by DXA while none had osteopenia/osteoporosis by CT. There was no correlation between immunologic/virologic parameters and BMD by either method. Increased osteoclastic activity was noted in 10 patients receiving tenofovir. In summary, decreased BMD diagnosed by DXA in pediatric HIV-infected subjects was not confirmed by CT. Increased bone turnover in patients on tenofovir was suggested by laboratory markers. Prospective studies using CT as the imaging standard are needed for evaluation of bone mineral changes in HIV-infected children.
Preliminary screening of osteoporosis and osteopenia in urban women from Jammu using calcaneal QUS  [cached]
Sharma Sudhaa,Tandon Vishal,Mahajan Annil,Kour Avinash
Indian Journal of Medical Sciences , 2006,
Abstract: BACKGROUND: Osteoporosis is a major public health problem, associated with substantial morbidity and socio-economic burden. An early detection can help in reducing the fracture rates and overall socio-economic burden in such patients. AIM: The present study was carried out to screen the bone status (osteopenia and osteoporosis) above the age of 25 years in urban women population in this region. MATERIALS AND METHODS: A hospital based study was carried out in 158 women by calculating T-scores utilizing calcaneal QUS as diagnostic tool. RESULTS: The result suggested that a substantial female population had oesteopenia and osteoporosis after the age of 45 years. The incidence of osteoporosis was (20.25%) and osteopenia (36.79%) with maximum number of both osteoporosis and osteopenic women recorded in the age group of (55-64 years). After the age of 65 years, there was an almost 100% incidence of either osteopenia or osteoporosis, indicating that it increases with age and in postmenopausal period, thereby suggesting lack of estrogenic activity might be responsible for this increasing trend. Religion, caste and diet had an influence on the outcome of osteopenic and osteoporosis score in present study, but still it has to be substantiated by conducting larger randomized clinical trials in future. CONCLUSION: A substantial female population was screened for osteoporosis and osteopenia using calcaneal QUS method utilizing same WHO T score criteria that otherwise shall remain undiagnosed and face the complications and menace of osteoporosis.
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