Poster Presentation ESA-SRB-ANZBMS 2024 in conjunction with ENSA

Prevalence of HIV-associated osteoporosis and fracture risk in mid-life women: a cross-sectional study in Zimbabwe (#372)

Mícheál Ó Breasail 1 2 , Tafadzwa Madanhire 3 4 , Cynthia Mukwasi-Kahari 3 4 , Farirayi Kowo-Nyakoko 3 5 , Peter R Ebeling 6 , Rashida A Ferrand 3 7 , Kate A Ward 5 8 , Celia L Gregson 3 9
  1. Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
  2. Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
  3. The Health Research Unit (THRU), Biomedical Research and Training Institute, Harare, Zimbabwe
  4. Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
  5. MRC Lifecourse Epidemiology Centre, Human Development and Health, University of Southampton, Southampton, UK
  6. Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Monash Medical Centre, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia, Clayton, VIC, Australia
  7. Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
  8. MRC Unit the Gambia at London School for Hygiene and Tropical Medicine, Banjul, The Gambia
  9. Global Musculoskeletal Research Group, Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK

Background: Antiretroviral therapy (ART) has dramatically reduced HIV related-mortality; more women now reach menopause. Menopausal estrogen loss causes bone loss, as does HIV and ART, though data describing HIV’s impact on osteoporosis prevalence and fracture risk are scarce in southern Africa.

Methods: A cross-sectional study of women aged 40-60 years (49% living with HIV (WLH)) was conducted in Harare. Menopause, fracture and HIV history were collected, and anthropometry and bone mineral density (BMD, by dual-energy x-ray absorptiometry (DXA)) measured, and FRAX® 10-year fracture probabilities quantified. The FRAX® probability of a major osteoporotic fracture (MOF) included HIV as a risk factor for secondary osteoporosis. Linear and Poisson regression determined relationships between clinical risk factors and femoral neck (FN)BMD and 10-year FRAX® MOF probability, respectively.

Results: The 393 participants were mean(SD) age 49.6(SD5.8) years and BMI 29.1(6) kg/m2. 95% of WLH were ART established (85%TDF) and 81% had a viral load <50 copies/mL. A BMD T-Score ≤-2.5 was more common in WLH than those without, at both FN and lumbar spine(LS) (FN 11.4% vs 2.5%, LS 20.8% vs 4.5%; respectively)(Figure 1). Prior fracture was more prevalent in WLH: any fracture (27[14%] vs. 14[7%]); MOF (14[7.3%] vs. 5[2.5%]). WLH had a higher 10-year MOF probability [median 1.2%; IQR: 0.9-1.8] compared with those without HIV [1.0%; IQR: 0.9-1.5](P<0.001), although probabilities were low. Older age, low weight, and HIV were strongly associated with lower FN BMD. Higher probability of MOF was associated with older age, HIV, parental hip fracture and prior fracture, though adjustment attenuated the association with HIV. No woman reported anti-osteoporosis medication use.

Conclusions: While osteoporosis and previous fractures were common and untreated in this relatively young population, particularly in WLH, FRAX® predicted 10-year MOF risk was low. Clinical risk factors considered in fracture risk prediction tools in Zimbabwe may need contextual modification.66a97baf59eec-Fig+for+ANZBMS+abstract.png