P16. Prevalence of osteoporosis in people living with Human Immunodeficiency Virus in a large outpatient clinic in Copenhagen, Denmark

Maria Wessman1, Kristina Thorsteinsson1, Anne-Mette Lebech1,2, An-Brit Eg Hansen1, Terese L. Katzenstein3, Nina Weis1,2
Affiliates: 1Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark, 2Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark, 3Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark

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Background
People living with Human Immunodeficiency Virus (PLWH) (HIV) have a higher prevalence of osteoporosis than HIV uninfected people. It remains uncertain whether the risk of low bone mineral density (BMD) is caused by HIV infection per se, complications of antiretroviral therapy (ART) or life-style factors such as smoking or low body weight. The primary objective of this cross-sectional study was to determine the BMD of PLWH attending an outpatient clinic in Copenhagen, Denmark, by performing Dual-energy X-ray absorptiometry (DXA) scans. The secondary objective was to gain information on body mass index (BMI), smoking, alcohol consumption, previous fractures and menopause.

Methods
Patients were recruited 4/1-30/6-2016, when attending regular outpatient visits at one of the largest Departments of Infectious Diseases in Denmark, at Copenhagen University Hospital, Hvidovre. Men living with HIV (MLWH) aged 50-70 years and women living with HIV (WLWH) aged 40-70 years, with fully suppressed HIV RNA for at least a year, and with no significant co-morbidities, were included. Patients completed a questionnaire on BMI, general health, exercise habits, smoking, alcohol consumption, previous fractures and for women; menopause-related questions. A DXA scan was performed at the Department of Clinical Physiology and Nuclear Medicine. Here we present data from the questionnaire and the DXA scans.

Results
A total of 70 patients were included; 45 MLWH and 25 WLWH. All patients were in ART, with fully suppressed viral loads and CD4 cell counts > 350 cells/mm3.
The median age at inclusion was 58 years for men and 49 years for women. The median duration of HIV infection was longer for men than for women; 42 and 21 years (p<0.0001), respectively. Ethnicity was predominantly European for men (42 (93 %)) and women (15 (60 %)). Mode of transmission was through sex with other men (MSM) for the majority of men (37 (82 %)) and heterosexual (24 (96 %)) for women. Almost a quarter of both men (10 (22 %)) and women (6 (24 %)) had a prior history of AIDS diagnoses.
Almost 90 % (38 men, 24 women) reported to be in good, very good or excellent health. A vast majority reported to exercise to some extent. Despite this, almost half of both men (17 (40 %)) and women (12 (48 %)) were overweight with a BMI >25.
Alcohol consumption was low for both men and women.  Of the 31 (68 %) men and 15 (60 %) women with a history of smoking, 19 (60 %) men and 7 (50 %) women reported to have more than 10 pack years. Smoking status was not associated with previous fractures (p 0.635).  Of the 14 women (56 %) who reported to be menopausal, 10 (40 %) had entered menopause due to natural causes (i.e. not due to surgery or hormone treatment). Median age at menopause was 56 years (IQR 51-59 years).
The DXA scans were abnormal in more than 70 % (36 men, 14 women) of the participants; showing osteopenia (T-score -1.0 – -2.5 standard deviations) in 28 (62 %) men and 13 (52 %) women and osteoporosis (T-score > -2.5 standard deviations) in 8 (18 %) men and 1 (4 %) woman. There was no significant difference in BMD distribution between men and women (p 0.0663).

Conclusions
In this cross-sectional study of PLWH in Copenhagen we found a high proportion (70 %) of pathological DXA scans with especially high rates of osteopenia. The significance of the high rates of osteopenia is unclear, and the pathogenesis of low BMD in PLWH remains unknown.
Therefore, we plan further studies; comparing DXA scans with an HIV uninfected control group and analyzing blood samples for specific bone markers.