Oral Presentation 33rd ASM of the Australian & New Zealand Bone & Mineral Society 2023

Impact of HIV on radial bone density, geometry, and strength in midlife Zimbabwean women and association between pQCT outcomes and fracture (#47)

Mícheál Ó Breasail 1 2 , Cynthia Mukwasi-Kahari 3 4 , Tafadzwa Madanhire 3 4 , Victoria Simms 3 4 , Lisa K Micklesfield 5 , Rashida A Ferrand 3 4 , Celia L Gregson 3 6 , Kate A Ward 7 8
  1. 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
  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. London School of Hygiene and Tropical Medicine, London, UK
  5. SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics , School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
  6. Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
  7. MRC Lifecourse Epidemiology Centre , University of Southampton, Southampton, UK
  8. MRC Unit the Gambia at London School for Hygiene and Tropical Medicine, Banjul, The Gambia

Background: HIV and its treatment are associated with deficits in bone and increased fracture risk; however, limited data are available from sub-Saharan African women during midlife, and importantly during the menopause transition.  We used peripheral QCT to measure radial BMD, geometry, and strength in pre-, peri-, and postmenopausal Zimbabwean women living with (WLWH) and without HIV (WLWOH) and determined whether pQCT measures were associated with self-reported fractures.

Methods: Scans were obtained from 384 women aged 40-61 years (n=191[49%] WLWH). pQCT outcomes were: 4% trabecular volumetric BMD (Trab.vBMD, mg/cm3), total area (Tot.A4, mm2), and compressive bone strength (BSIc, g2/cm4); 33% cortical vBMD (Ct.vBMD, mg/cm3), total area (Tot.A33, mm2), and Stress-Strain Index (SSI, mm3).  Height (m), weight (kg) and menopause status based on last menstrual period were recorded. Linear regression investigated differences adjusting for age, menopause stage, and height, and then additionally for weight. In all women, odds ratios were calculated to explore associations between pQCT measures and self-reported 1) any fracture; 2) major osteoporotic fracture.

Results: Women were of mean(SD) age 49.6(5.8) years and BMI 29.0(6.1) kg/m2. WLWH women had lower weight and BMI (both p<0.001). All pQCT outcomes were lower in WLWH before adjustment (all p<0.05, Table 1), and robust to adjustment for age, menopause stage, and height (all p<0.05) apart from Tot.A33. Further adjustment for weight attenuated Tot.A4 and SSI between-group differences (Table 1). Tot.A33 and SSI were associated with lower odds of previous major osteoporotic fracture (OR[95%CI]: Tot.A33, 0.57[0.34;0.94]; SSI,  0.58[0.34;0.97].  

Conclusion(s): In perimenopausal women HIV impacts BMD and strength at the distal radius, a common osteoporotic fracture site.  These relationships were robust to initial adjustment, though the addition of weight to the models reduced the effect size. Numbers of reported fractures were low, but in the whole group analysis, radius cortical parameters were associated with fracture.

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