Background:  Bone demineralization occurs more frequently in HIV⁺ patients than in HIV^– controls. We evaluated bone mineral density at the lumbosacral spine and total hip regions in a cohort of HIV⁺ males, and compared the extent of bone loss to that in HIV^– subjects at risk of bone demineralization.

Methods:  DEXA scans performed on stable, treated HIV⁺ males were reviewed to determine lumbosacral and total hip T scores and prevalence of bone mineral density loss. These results were compared to DEXA available from historical controls consisting of unselected, HIV^– males referred for bone mineral density evaluation. Controls were age matched 1:1 to cases. Cases and controls were categorized as £50 or >50 years old to evaluate age-related effects. Median (95%±CI) T scores were compared by the Mann-Whitney U test. Differences between anatomic site-related prevalence of normal WHO-determined bone mineral density were compared by the c² test.

Results:  DEXA scans on 127 treated HIV⁺ males (median age 47 [46 to 49], range 29 to 77, median CD4 435 [357 to 480], 65% with viral load <50), were compared to 127 HIV^– males. T scores at the lumbosacral and total hip regions in cases and controls, both £50 and >50 year olds are presented in the table. The T score at the total hip in younger HIV⁺ patients was lower than in younger HIV^– patients (–1.8 [–2.0 to –1.3] vs –1.0 [–1.4 to –0.8], p = 0.0000). At the total hip there were fewer younger HIV⁺ vs HIV^– patients with normal bone mineral density (26% vs 53%, p = 0.0007). The prevalence of normal bone mineral density at the total hip was less in younger HIV⁺ than in older HIV^– patients (26% vs 55%, p = 0.03). The prevalence of normal bone mineral density at the lumbosacral was similar in HIV^– vs HIV⁺ patients regardless of age.

Conclusions:  In both younger and older treated HIV⁺ males, more bone mineral density loss occurs at the total hip than at the lumbosacral spine. This differs from the pattern of bone mineral density loss observed in age-matched controls wherein the bone mineral density is similar at the total hip and the lumbosacral regions in both younger and older subjects. Significantly, the extent of bone mineral density loss at the hip in younger HIV⁺ males is greater than in older controls. This preferential loss of hip bone mineral density, occurring much earlier in this population, may predict an increased risk of morbidity and fragility fractures.