Background: Few studies have examined the prevalence of osteoporosis and HIV associated risk factors for low bone density (BMD) in postmenopausal (PM) women with HIV.

Methods: We conducted a cross sectional study of 31 PM HIV⁺ women. BMD by DXA was assessed at the lumbar spine (LS) and femoral neck (FN) and potential risk factors were elicited. Univariate analysis was performed with Chi square and T-tests and multivariate analysis with linear regression. Means are reported ± SEM.

Results: Mean age was 55 ±1 with a mean time since menopause of 10 ±2 yrs; 75% were Hispanic and 22% African American. Mean duration of HIV diagnosis was 92 ±7 mos. Antiretroviral therapy (ART) was initiated in 87% for a mean duration of 60 ±8 mos. In addition to nucleosides, 36% were exposed to PI and NNRTI, 36% to PI, and 7% to NNRTI. Mean LS T score was –1.88 ±0.3. By WHO criteria, 32% had osteopenia and 42% had osteoporosis at the LS; 39% had osteopenia and 19% had osteoporosis at the FN. In contrast to the 9%–16% prevalence reported in populations of similar age and ethnicity, prevalence of LS osteoporosis was 43% in Hispanics and 42% in African Americans. Ten percent (10%) had anterior wedge compression fractures (VCF) on vertebral morphometry. Mean LS T score was -3.37 ±1.4 for those with VCF and -1.72 ±0.3 for those without VCF (p = 0.086). In univariate analysis, low BMD (LS T score < -1) was significantly associated with longer duration of HIV diagnosis (p = 0.041), lack of hormone replacement therapy (p = 0.031), weight <127 lbs (p = 0.002), and lower current BMI (p < 0.0001). An association with time since menopause was near significance (p = 0.053). There were no significant associations with duration or class of ART, nadir CD4, AIDS diagnosis, or history of steroid use. The association with duration of HIV diagnosis was not significant after adjustment for time since menopause and BMI.

Conclusions: These data suggest that the prevalence of LS osteoporosis is considerably higher in HIV⁺ Hispanic and African American PM women than racially comparable healthy populations. However, in this small study, low BMD was associated with accepted osteoporosis risk factors and not with HIV or ART. Hispanics and African Americans account for over 80% of HIV⁺ women over age 50 in New York. As the female HIV population increases and ages, diagnosis and treatment of osteoporosis should play a more prominent role in their long-term management.