Background:  Quantitative ultrasound technique (QUS) is a promising technology for bone quality assessment that appears to be a good predictor of fractures. Dual Energy X-ray Absorptiometry (DEXA) is nowadays considered the “gold standard” to assess bone density but it has some limitations in predicting fracture risk. This study was designed to evaluate bone mass using these different approaches.

Methods:  Women were consecutively enrolled between May and September 2006. They performed in the same day:  DEXA (L2-L4 and femoral) and phalangeal QUS (AD-SoS and UBPI, fracture-predictive value). Concurrent data were collected on medical and dietary history, CD4 count, HIV viral load, time known to be HIV⁺, hepatitis C virus (HCV) co-infection, and duration and type of ART.

Results:  We enrolled 83 women:  median age 42 years (range 19 to 73); 25 (30%) intravenous drug user (IDU); 16 (19.3%) in menopause; median body mass index 22 (range 14.6 ti 31.6); 35 (42.2%) lipodystrophy; 40 (48.2%) dyslipidemia; 9 (10.8%) AIDS; 28 (33.7%) HCV co-infection; 59 (71.1%) on HAART. Mean and median values obtained from the 2 techniques are reported in the table. Number of patients with z-score ≤ –2 and < –1, by DEXA and QUS AD-SoS measurements, were:  6% vs 23 %, respectively. Mean QUS-UBPI z-score was –0.33, and UBPI z-score ≤ –2 was found in 9 subjects (10.8%). Median fracture risk was 19%. Lower quality, by QUS, was only correlated with disease length (r –0.23, p = 0.05). Moreover mean AD-SoS was lower in subjects with lipodystrophy (–0.62 vs –0.29). No differences were found in patients with HCV co-infection (mean AD-SoS – 0.40 vs –0.46). Factors correlated with femoral DEXA were disease length and protease inhibitors duration (r –0.45 and –0.31, respectively, p = 0.05). No correlation was found L2-L4 DEXA. The correlation between QUS and DEXA is significant (r = 0.30, p = 0.05). IDU patients were statistically associated with loss of bone mineral density (femoral p = 0.03, L2-L4 p = 0.17, and AD-SoS p = 0.06).

Conclusions: A non-invasive technique. such as QUS technology, opens new and interesting perspectives, allowing following of bone status changes in young women with HIV infection, better evaluation of the role of disease-related conditions or treatments that can  interfere with bone mass, and giving more information on fracture risk.