Background:  Chronic viral hepatopathy is a risk factor of bone demineralization. Little is known about the temporal changes of bone abnormalities in HIV-infected patients. We examined the 2-year progression of bone mineral density and body composition in a cohort of HIV-infected patients and estimated the prevalence of osteoporosis/osteopenia according to the hepatitis co-infection status.

Methods:  Patients were consecutively screened for bone mineral density and hepatitis co-infection from November 2004 to May 2005. The prevalence of osteoporosis was 26.8%. We repeated the bone mineral density assessment 2 years later in patients who had no bone abnormality or osteopenia diagnosis at baseline (WHO criteria). We expanded in 2007 the enrolment of hepatitis co-infected patients to estimate the bone mineral density prevalence in this group. Bone mineral density of whole body, lumbar spine, and femoral neck was measured by dual energy X-ray absorptiometry (DEXA), as well as bone mineral content and fat and lean body mass.

Results:  We repeatedly assessed 208 patients in the longitudinal study (67.8% male; median age 46 years; 26.7% with normal bone mineral density and 73.3% with osteopenia at baseline). After 2 years, 39 patients (18.7%) remained free of bone abnormality; osteopenia was diagnosed in 147 patients (70.7%) and osteoporosis in 22 (10.6%). Osteopenia predominated at the femoral neck in both men and women, and osteoporosis at the femoral neck in men. A fat mass significant decline (median –2.9%) was observed in those acquiring osteopenia compared to those remaining normal (+7.5%) (p = 0.01). Osteopenic patients at baseline presented a significant femoral neck bone mineral density decline when becoming osteoporotic (–4.2%) compared to those who remained osteopenic (–1.9%) (p <10^–3). Bone mineral density was investigated in 103 hepatitis co-infected patients (66% hepatitis C virus [HCV], 31% hepatitis B virus [HBV], 3% both; 71.8% male; 28.2% AIDS stage; 88.2% treated by HAART; 11% with cirrhosis). Prevalence of osteopenia was 52.5% in men (95%CI 40.0 to 65.0%), and 58.3% among women (38.6 to 78.0%). Osteoporosis was diagnosed in 34.4% of men (22.5 to 46.3%) and 8.3% of women (2.7 to 19.3%). These prevalence estimates of bone demineralization were not significantly different from those documented in patients with HIV monoinfection 2 years earlier.

Conclusions:  This study confirms our earlier findings of a high prevalence of bone mineral disorders in HIV patients. However, we did not observe any association with viral hepatitis co-infection. Bone metabolism is rapidly evolving in 2 years among HIV-infected patients and underlying biological mechanisms need further investigation.