Chronic Kidney Disease Is Associated with Bone Mineral Density Loss among Elderly HIV-infected Individuals in Japan
Methods: We analyzed BMD in 178 elderly HIV-infected individuals (defined as greater than 40 years of age) who were consulting us in our outpatient clinic. Dual-energy X-ray absorptiometry scan of lumbar spine and femoral neck was obtained at the clinical visit. Low BMD was defined as T-score less than -1. HIV-related factors (CD4 cell count, HIV viral load, ART duration, tenofovir exposure years, and ritonavir-boosted protease inhibitor exposure years), and comorbidities [hypertension, diabetes mellitus (DM), dyslipidemia, chronic kidney disease (CKD), and HBV/HCV coinfection] were evaluated by reviewing medical charts. The definition of CKD was based on the 2012 KDIGO CKD classification, determined using combinations of 5 stages of eGFR and 3 grades of albuminuria. Risk factors for low BMD were determined using multivariate logistic regression analysis.
Results: The mean age was 54.1 years, 97% were Japanese, 94% were male. ART was performed in 96% of cases and 52% of them have been treated by regimens that contained tenofovir. The mean CD4 cell count was 504.2/μL and 88% had undetectable HIV-RNA level. Osteopenia and osteoporosis were diagnosed in 38% and 8% of the patients at lumbar spine, and 51% and 7% at femoral neck, respectively. The prevalence of CKD was 23%. In multivariate analysis, factors associated with low BMD at femoral neck were age [hazard ratio (HR) 1.059 per 1 year increase; 95% confidence interval (CI) 1.006-1.114; P=0.028], body mass index (HR 0.892, 95%CI 0.805-0.989; P=0.030), DM (HR 0.189, 95%CI 0.049-0.733; P=0.016), and CKD (HR 2.990, 95%CI 1.138-7.854; P=0.026).
Conclusion: In elderly Japanese HIV-infected individuals, age and CKD were correlated with femoral neck BMD loss. BMI and DM were inversely correlated with BMD loss. The influences of HIV-related factors for BMD loss were not identified in this study.
N. Yanagisawa, None
I. Seita, None
M. Yotsumoto, None
M. Otaki, None
T. Hagiwara, None
T. Suzuki, None
K. Amano, None
K. Fukutake, None