Effects of Weight,
Body Composition, and Testosterone on Bone Mineral Density in HIV Positive Women
Past
studies have produced conflicting data on the prevalence of and risk factors for
bone loss -- including mild osteopenia and more severe osteoporosis -- in HIV
positive women.
As
reported in the June 1, 2007 Journal of Acquired Immune Deficiency Syndromes,
researchers from Massachusetts General Hospital and Harvard Medical School conducted
a study to examine the effects of reduced androgen levels, changes in weight,
body composition, and menstrual dysfunction on bone mineral density (BMD).
The
study included 152 HIV positive women and 100 HIV negative control subjects. Among
the HIV positive women, 124 had a normal body weight (greater than 90% ideal body
weight), while 28 were low weight (90% or less of ideal body weight).
BMD
was assessed using dual x-ray absorptiometry, and free testosterone was assessed
by equilibrium dialysis. Abdominal subcutaneous adipose tissue and visceral adipose
tissue were determined using computed tomography.
Results
•
A
significant difference in BMD was observed between the HIV positive low weight,
HIV positive normal weight, and HIV negative groups:
- lumbar spine (0.92
vs 1.01 vs 1.07 g/cm; P < 0.0001); - total hip (0.84 vs 0.94 vs 0.98 g/cm;
P < 0.0001); - femoral neck (0.73 vs 0.83 vs 0.87 g/cm; P < 0.0001).
•
Among
the HIV positive women, lumbar BMD correlated with:
- percentage of ideal
body weight (r = 0.37; P < 0.0001); - total body lean mass (r = 0.43; P
< 0.0001); - total body fat mass (r = 0.35; P < 0.0001); - subcutaneous
adipose tissue (r = 0.41; P < 0.0001).
•
However,
lumbar BMD did not correlate with visceral adipose tissue (r = 0.07; P =0.417).
•
Among
the HIV positive women, clinical risk factors for osteopenia and osteoporosis
identified in a univariate analysis included:
- low free testosterone (<1.1
pg/mL, the lower limit of the normal range of free testosterone for women, or
3.8 pmol/L; P = 0.0007); - low body weight (P = 0.014); - sparse menstruation
(P = 0.0006).
•
In
a multivariate regression analysis, lean body mass was most significantly associated
with BMD among HIV positive women.
Conclusion
In
conclusion, the authors wrote, "These data demonstrate that BMD is reduced
among HIV-infected women in association with low weight, reduced lean mass, reduced
androgen levels, and abnormal menstrual function."
06/15/07
Reference SE
Dolan, S Carpenter, and S Grinspoon. Effects of Weight, Body Composition, and
Testosterone on Bone Mineral Density in HIV-Infected Women. JAIDS 45(2):
161-167. June 1, 2007.
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Past
studies have produced conflicting data on the prevalence of and risk factors for
bone loss -- including mild osteopenia and more severe osteoporosis -- in 
