Background: Osteopenia is a recently described adverse event in HIV-infected patients that may be a side effect of protease-inhibitor use, and is also a well-known sequela of menopause and normal aging in women. To date, no studies have described the prevalence of reduced bone mineral density BMD in older, peri- and post-menopausal HIV-infected women.

Methods: We analyzed BMD of the lumbar spine, hip, and total body in 40 older (age >35) women, including 19 HIV-infected and 21 HIV-uninfected women. We also analyzed the impact of protease-inhibitor (PI) use on BMD.

Results: The median age of subjects was 48 years (range 35-55). 50% (n=20) were defined as post-menopausal (age >40 and no menses in the past one year), and 50% were defined as perimenopausal (age >35 and irregular menses, or age >40 and regular menses). 49% were African American, 32% Hispanic, and 19% white. Mean body weight was 72.5 kg (range 48-106). Among HIV-infected women, all had taken antiretroviral therapy and 55% (n=11) had taken PIs. The prevalence of osteopenia (defined as lumbar spine, femoral neck, or total body T-score < -1.0) was 50% among HIV-infected post-menopausal women, 44% among HIV-uninfected post-menopausal women, 25% among HIV-infected peri-menopausal women, and 40% among HIV-uninfected peri-menopausal women.  Among HIV-infected women, 60% of PI-using women had osteopenia compared to 13% of women who had not used PIs (p=0.04), and this association remained after controlling for age and body weight. Mean BMD and median t-scores for the lumbar spine (LS) and femoral neck (hip) are shown in the table:

	HIV+post	HIV-post	HIV+peri	HIV-peri	HIV+PI+	HIV+PI-
	(N=10)	(N=9)	(N=8)	(N=10)	(N=10)	(N=8)
LS  BMD	1.20	1.14	1.24	1.24	1.14	1.30
Hip BMD	0.95	0.91	1.06	1.04	0.94	1.06
LS t-score	-0.27	-0.45	-0.10	0.28	-0.60	0.32
Hip t-score	-0.84	-0.60	0.18	0.10	-0.90	0.06

Conclusions: Protease inhibitor use is independently associated with significantly decreased bone mineral density in older HIV-infected women.