Reduced bone density in androgen-deficient women with acquired immune deficiency syndrome wasting

• Published in: The journal of clinical endocrinology and metabolism Vol. 86; no. 8; pp. 3533 - 3539
• Main Authors: HUANG, Jeannie S, WILKIE, Stephanie J, SULLIVAN, Meghan P, GRINSPOON, Steven
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Endocrine Society 01.08.2001
• Subjects: Absorptiometry, Photon; Adipose Tissue - anatomy & histology; Adult; Analysis of Variance; Androgens - deficiency; Biological and medical sciences; Biomarkers - blood; Body Mass Index; Body Weight; Bone Density; Bone Resorption; Collagen - analysis; Collagen - blood; Collagen Type I; Diseases of the osteoarticular system; Estrogens - blood; Female; HIV Wasting Syndrome - blood; HIV Wasting Syndrome - physiopathology; Human immunodeficiency virus; Human viral diseases; Humans; Infectious diseases; Medical sciences; Miscellaneous. Osteoarticular involvement in other diseases; Multivariate Analysis; Muscle, Skeletal - anatomy & histology; Peptides - blood; Reference Values; Regression Analysis; Testosterone - blood; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Weight Loss; Diseases of the osteoarticular system; Bone disease; Density; Blood plasma; Body mass index; Turnover; Adult; Complication; Female; Testicular hormone; Hormonal investigation; Osteopenia; Human; Immunopathology; Androgen; AIDS; Immune deficiency; Infection; Testosterone; Bone mass; Viral disease; Risk factor; Bone mineral density; Sex steroid hormone; Osseous tissue
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.86.8.3533

Women with acquired immune deficiency syndrome wasting are at an increased risk of osteopenia because of low weight, changes in body composition, and hormonal alterations. Although women comprise an increasing proportion of human immunodeficiency virus-infected patients, prior studies have not investigated bone loss in this expanding population of patients. In this study we investigated bone density, bone turnover, and hormonal parameters in 28 women with acquired immune deficiency syndrome wasting and relative androgen deficiency (defined as free testosterone < or =3.0 pg/ml, weight < or =90% ideal body weight, weight loss > or =10% from preillness maximum weight, or weight <100% ideal body weight with weight loss > or =5% from preillness maximum weight). Total body (1.04 +/- 0.08 vs. 1.10 +/- 0.07 g/cm2, human immunodeficiency virus-infected vs. control respectively; P < 0.01), anteroposterior lumbar spine (0.94 +/- 0.12 vs. 1.03 +/- 0.09 g/cm2; P = 0.005), lateral lumbar spine (0.71 +/- 0.14 vs. 0.79 +/- 0.09 g/cm2; P = 0.02), and hip (Ward's triangle; 0.68 +/- 0.14 vs. 0.76 +/- 0.12 g/cm2; P = 0.05) bone density were reduced in the human immunodeficiency virus-infected compared with control subjects. Serum N-telopeptide, a measure of bone resorption, was increased in human immunodeficiency virus-infected patients, compared with control subjects (14.6 +/- 5.8 vs. 11.3 +/- 3.8 nmol/liter bone collagen equivalents, human immunodeficiency virus-infected vs. control respectively; P = 0.03). Although body mass index was similar between the groups, muscle mass was significantly reduced in the human immunodeficiency virus-infected vs. control subjects (16 +/- 4 vs. 21 +/- 4 kg, human immunodeficiency virus-infected vs. control, respectively; P < 0.0001). In univariate regression analysis, muscle mass (r = 0.53; P = 0.004) and estrogen (r = 0.51; P = 0.008), but not free testosterone (r = -0.05, P = 0.81), were strongly associated with lumbar spine bone density in the human immunodeficiency virus-infected patients. The association between muscle mass and bone density remained significant, controlling for body mass index, hormonal status, and age (P = 0.048) in multivariate regression analysis. These data indicate that both hormonal and body composition factors contribute to reduced bone density in women with acquired immune deficiency syndrome wasting. Anabolic strategies to increase muscle mass may be useful to increase bone density among osteopenic women with acquired immune deficiency syndrome wasting.