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Background:  There have been reports of osteoporosis and osteopenia in HIV-infected men, with equivocal findings on whether this is the result of, or alternatively, attenuated by use of highly active antiretroviral therapy (HAART). There is minimal data regarding how HIV infection or its treatment affects bone mineral density in women.

Methods:  In 88 HIV^- and 184 HIV⁺ women (90 not on HAART, and 94 on HAART) enrolled in the Women’s Interagency HIV Study, we measured bone mineral density by separate site-specific dual X-ray absorptiometry (DEXA) at 3 sites:  spine, femoral trochanter, and femoral neck. Results were analyzed by HIV infection and treatment status, adjusted for age, race, body mass index, and pre-HAART nadir CD4 cell count, using ANOVA and ANCOVA.

Results:  Bone mineral density was 6 to 8% lower in the HIV⁺ than in the HIV^- women (p <0.03 at all sites) with similar bone mineral density in the HIV⁺ women taking or not taking HAART. Only 5 women (1.8%) had a t-score indicative of osteoporosis (<-2.5). The prevalence of osteopenia/osteoporosis at any site, defined as t-score <-1.0, was 6.4% in the HIV^- women, 18.9% in the HIV⁺ women not on HAART and 20.4% in women receiving HAART (adjusted OR 3.15, p = 0.027 in all HIV⁺ vs HIV^- women). Longer nevirapine use was significantly associated with higher bone mineral density, and longer abacavir use with lower bone mineral density. White race, lower body mass index and self-reported postmenopausal status were also independently associated with lower bone mineral density (see the table). 

Conclusions:  Lower bone mineral density and osteopenia or osteoporosis in women were associated with HIV infection and with specific antiretroviral agents, suggesting that this group of predominately premenopausal women may be at increased risk of bone fracture.

Keywords: osteopenia; bone mineral density; HAART