Background:  Accelerated bone mass loss (osteopenia and osteoporosis) have recently been described in HIV-infected patients. Underlying mechanisms leading to these complications are thought to be multifactorial. We conducted a cross-sectional survey within a cohort of HIV-infected patients to estimate the prevalence of bone abnormalities and to investigate factors associated with.

Methods:  Patients included in the ANRS CO 3 Aquitaine Cohort were consecutively enrolled between November 2004 and May 2005. Bone mineral density of total body, lumbar spine, and femoral neck was measured by dual energy x-ray absorptiometry. Osteopenia and osteoporosis were defined according to World Health Organization criteria based on T scores. Multivariate logistic regression was performed to identify epidemiological, clinical, biological, and therapeutic factors associated with a diagnosis of osteopenia or osteoporosis.

Results:  We enrolled 492 patients of whom 72.4% were male; median age, 43 years (interquartile range [IQR] 38 to 50); 97 (19.7%) were at the AIDS stage; 140 (28.5%) had lipodystrophy. Osteopenia was diagnosed in 267 (54.3%) patients and osteoporosis in 125 (25.4%) patients (Table 1). Factors associated with osteoporosis were:  male gender (adjusted OR[aOR] = 14.0; 95% confidence interval [CI] 6.0 to 32.2; p <10-4), lipodystrophy (aOR = 2.6; 95%CI 1.2 to 5.5; p = 0.01), alcohol consumption (aOR = 2.4; 95%CI 1.0 to 5.5; p = 0.04), and older age (aOR = 1.0; 95%CI 1.0 to 1.1; p = 10-4), whereas male gender (aOR = 3.0; 95%CI 1.8 to 4.9; p <10-4), AIDS stage (aOR = 2.5; 95%CI 1.2 to 5.4; p = 0.02), and older age (aOR = 1.0; 95%CI 1.0 to 1.1; p = 0.05) were significantly associated for osteopenia.

Conclusions:  These data show a high prevalence of osteopenia and osteoporosis in our cohort. The multifactorial hypothesis is substantiated by the associations found. Mechanisms and consequences of those bone disorders need to be further explored.