Inverse Correlation Between Vascular Calcification and Bone Mineral Density in Human Immunodeficiency Virus-Infected Patients
Calcified Tissue International, August 2013
Giovanni Guaraldi, giovanni.guaraldi at unimore.it
HIV-infected individuals suffer from accelerated aging, which manifests as premature cardiovascular and bone disease. However, little is known of the association of these two disorders in the HIV population. Our objective was to investigate the association between a marker of atherosclerosis (coronary artery calcium [CAC]) and low bone mineral density (BMD) in a cross-sectional cohort of HIV-infected patients. The study was conducted at the University of Modena and Reggio Emilia, Italy. A total of 636 consecutive middle-aged, HIV-infected subjects were recruited between January 2006 and December 2010. All patients underwent CAC and BMD assessment. Patients were categorized according to a CAC score <100 or >100 units based on previous literature that identified this cut-point as a marker of increased risk.
Low femoral and lumbar spine BMD was defined as <25th percentile value for the study cohort. Logistic regression and bootstrap analysis were used to assess the independent association between CAC and BMD. The main outcome measure was a CAC score >100. Patients with CAC > 100 were older and more likely to be men, diabetic, and overweight. Patients with CAC < 100 had better renal function and a lower cardiovascular risk profile.
After adjusting for age, sex, traditional and HIV-specific risk factors, vitamin D level, and PTH level, there was a significant association between CAC > 100 and low BMD for the femur (OR = 2.33, 95 % CI 1.09–4.99; p = 0.02) but not for the spine.
Bootstrap analyses confirmed these findings.
In summary, CAC was independently associated with low femoral BMD in HIV-infected patients.
Future studies should test whether therapies that attenuate cardiovascular risk in HIV favorably impact bone health.
- Aberg JA (2012) Aging, inflammation, and HIV infection. Top Antivir Med 20:101–105
- Cozzolino M, Vidal M, Arcidiacono MV, Tebas P, Yarasheski KE, Dusso AS (2003) HIV-protease inhibitors impair vitamin D bioactivation to 1,25-dihydroxyvitamin D. AIDS 17:513–520 CrossRef
- Detrano R, Guerci A, Carr J, Bild D, Burke G, Folsom A, Liu K, Shea S, Szklo M, Bluemke D, O’Leary D, Tracy R, Watson K, Wong N, Kronmal R (2008) Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 358:1336–1345 CrossRef
- Raggi P, Giachelli C, Bellasi A (2007) Interaction of vascular and bone disease in patients with normal renal function and patients undergoing dialysis. Nat Clin Pract Cardiovasc Med 4:26–33 CrossRef
- Jono S, McKee MD, Murry CE, Shioi A, Nishizawa Y, Mori K, Morii H, Giachelli CM (2000) Phosphate regulation of vascular smooth muscle cell calcification. Circ Res 87:E10–E17 CrossRef
- Achenbach S, Ropers D, Mohlenkamp S, Schmermund A, Muschiol G, Groth J, Kusus M, Regenfus M, Daniel WG, Erbel R, Moshage W (2001) Variability of repeated coronary artery calcium measurements by electron beam tomography. Am J Cardiol 87(210–213):A218
- Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832 CrossRef
- Sauerbrei W, Schumacher M (1992) A bootstrap resampling procedure for model building: application to the Cox regression model. Stat Med 11:2093–2109 CrossRef
- Guaraldi G, Zona S, Alexopoulos N, Orlando G, Carli F, Ligabue G, Fiocchi F, Lattanzi A, Rossi R, Modena MG, Esposito R, Palella F, Raggi P (2009) Coronary aging in HIV-infected patients. Clin Infect Dis 49:1756–1762 CrossRef
- Guaraldi G, Zona S, Orlando G, Carli F, Ligabue G, Fiocchi F, Rossi R, Modena MG, Raggi P (2012) Progression of coronary artery calcium in men affected by human immunodeficiency virus infection. Int J Cardiovasc Imaging 28:1857–1860 CrossRef
- Brown TT, Qaqish RB (2006) Antiretroviral therapy and the prevalence of osteopenia and osteoporosis: a meta-analytic review. AIDS 20:2165–2174 CrossRef
- Bolland MJ, Barber PA, Doughty RN, Mason B, Horne A, Ames R, Gamble GD, Grey A, Reid IR (2008) Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. BMJ 336:262–266 CrossRef
- Bolland MJ, Avenell A, Baron JA, Grey A, MacLennan GS, Gamble GD, Reid IR (2010) Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ 341:c3691 CrossRef
- Reid IR, Gamble GD, Grey AB, Black DM, Ensrud KE, Browner WS, Bauer DC (2005) β-Blocker use, BMD, and fractures in the study of osteoporotic fractures. J Bone Miner Res 20:613–618 CrossRef
- Richards JB, Papaioannou A, Adachi JD, Joseph L, Whitson HE, Prior JC, Goltzman D, Group CMOSR (2007) Effect of selective serotonin reuptake inhibitors on the risk of fracture. Arch Intern Med 167:188–194 CrossRef
- Von Ruden AE, Adson DE, Kotlyar M (2008) Effect of selective serotonin reuptake inhibitors on cardiovascular morbidity and mortality. J Cardiovasc Pharmacol Ther 13:32–40 CrossRef
- Raggi P, Chertow GM, Torres PU, Csiky B, Naso A, Nossuli K, Moustafa M, Goodman WG, Lopez N, Downey G, Dehmel B, Floege J, Group AS (2011) The ADVANCE study: a randomized study to evaluate the effects of cinacalcet plus low-dose vitamin D on vascular calcification in patients on hemodialysis. Nephrol Dial Transplant 26:1327–1339 CrossRef
- Mccomsey GA, Tebas P, Shane E, Yin MT, Overton ET, Huang JS, Aldrovandi GM, Cardoso SW, Santana JL, Brown TT (2010) Bone disease in HIV infection: a practical review and recommendations for HIV care providers. Clin Infect Dis 51:937–946 CrossRef
- Fux CA, Rauch A, Simcock M, Bucher HC, Hirschel B, Opravil M, Vernazza P, Cavassini M, Bernasconi E, Elzi L, Furrer H, Study SHC (2008) Tenofovir use is associated with an increase in serum alkaline phosphatase in the Swiss HIV Cohort Study. Antivir Ther 13:1077–1082
- Shroff R, Egerton M, Bridel M, Shah V, Donald AE, Cole TJ, Hiorns MP, Deanfield JE, Rees L (2008) A bimodal association of vitamin D levels and vascular disease in children on dialysis. J Am Soc Nephrol 19:1239–1246 CrossRef
- Raggi P, Bellasi A, Ferramosca E, Block GA, Muntner P (2007) Pulse wave velocity is inversely related to vertebral bone density in hemodialysis patients. Hypertension 49:1278–1284 CrossRef
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- HIV inflammation markers associated with vitamin D less than 10 ng – Jan 2013
- HIV associated with low vitamin D and high C-reactive protein – Sept 2012
- HIV patients having EFC therapy were 3X more likely to have low vitamin D levels – Sept 2012
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- HIV leads to low vitamin D which leads to osteoporosis – a growing problem May 2012
- Vitamin D and Immune Function – Review July 2013