Evaluation of bone mineral density, microarchitecture, and detection of fractures on young patients living with human immunodeficiency virus: when and how to screen?

Autor:	Gehrke B; Programa de Pós-graduação em Fisiopatologia Clínica e Experimental (FISCLINEX) - Universidade Estadual do Rio de Janeiro, Rio de Janeiro, 20551-030, RJ, Brasil. barbara_gehrke@yahoo.com.br.; Centro de Pesquisa Clínica Multiusuário (CePeM) - Universidade Estadual do Rio de Janeiro, Rio de Janeiro, 20551-030, RJ, Brasil. barbara_gehrke@yahoo.com.br.; Divisão de Endocrinologia, Departamento de Medicina Interna, Faculdade de Ciências Médicas - Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro, 20550-900, RJ, Brasil. barbara_gehrke@yahoo.com.br., Farias MLF; Divisão de Endocrinologia - Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, 21941-590, RJ, Brasil., Wildemberg LE; Divisão de Neuroendocrinologia - Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, 20231-092, RJ, Brasil., Ferraiuoli GI; Divisão de Infectologia - Hospital Universitário Pedro Ernesto (HUPE)/Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, 20551-030, RJ, Brasil., Ribeiro V; Divisão de Infectologia - Hospital Universitário Pedro Ernesto (HUPE)/Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, 20551-030, RJ, Brasil., Bosgnoli R; Labhor - Laboratório de Hormônios da Endocrinologia - Hospital Universitário Pedro Ernesto (HUPE)/Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, 20551-030, RJ, Brasil., Paranhos Neto FP; Divisão de Endocrinologia - Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, 21941-590, RJ, Brasil., de Mendonça LMC; Divisão de Reumatologia, Departamento de Medicina Interna - Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, 21941-590, RJ, Brasil., Madeira M; Divisão de Endocrinologia - Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, 21941-590, RJ, Brasil., Coelho MCA; Programa de Pós-graduação em Fisiopatologia Clínica e Experimental (FISCLINEX) - Universidade Estadual do Rio de Janeiro, Rio de Janeiro, 20551-030, RJ, Brasil.; Centro de Pesquisa Clínica Multiusuário (CePeM) - Universidade Estadual do Rio de Janeiro, Rio de Janeiro, 20551-030, RJ, Brasil.; Divisão de Endocrinologia, Departamento de Medicina Interna, Faculdade de Ciências Médicas - Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro, 20550-900, RJ, Brasil.
Jazyk:	angličtina
Zdroj:	Endocrine [Endocrine] 2024 Jan; Vol. 83 (1), pp. 214-226. Date of Electronic Publication: 2023 Sep 06.
DOI:	10.1007/s12020-023-03501-9
Abstrakt:	Purpose: People living with the human immunodeficiency virus (PLWH) developed higher life expectancy along with chronic bone disease over the past years. Our purpose is to evaluate bone mineral density, bone microarchitecture and fractures in young PLWH and understand the disease's contribution to bone derangements and fracture risk. Methods: Eighty-one HIV-infected and 54 control young (20-50 years) male and female subjects were enrolled in this study. Methods for patient evaluation included DXA-VFA (dual energy X-rays and vertebral fracture assessment), HR-pQCT (high resolution peripheral quantitative computed tomography), biochemistry and FRAX. Results: Fifty participants from each group completed all exams. Median age was 40 (25-49) vs. 36.5 (22-50) for the HIV and control groups, respectively (p 0.120). Ethnicity, body mass index, serum phosphorus, 25-hydroxyvitamin D, PTH and CTX were similar between groups, although ALP and OC suggested higher bone turnover in PLWH. VFA identified morphometric vertebral fractures in 12% of PLWH. PLWH had lower values for lumbar spine areal BMD and Z score, volumetric BMD, trabecular bone fraction (BV/TV) and trabecular number measured at the distal tibia by HR-pQCT; as a consequence, trabecular separation and heterogeneity were higher (all p < 0.05). The FRAX-estimated risk for hip and major osteoporotic fractures was statistically higher in PLWH (p < 0.001). Conclusion: Our results confirm severe bone impairment and fractures associated with HIV in young patients. Thus, we developed a screening protocol for young PLWH to detect bone fragility, reduce skeletal disease progression and morbimortality, decrease fracture risk, and increase quality of life. (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze:	MEDLINE
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