Prevalence of low bone mineral density in women living with HIV and associated factors.

INTRODUCTION The success of antiretroviral therapy has increased life expectancy for people living with HIV, leading to age-related comorbidities such as bone loss. Women living with HIV face dual risks from chronic HIV infection and estrogen deficiency. This study aimed to determine the prevalence of low bone mineral density in women living with HIV on antiretroviral therapy and analyze associated factors, specifically tenofovir disoproxil fumarate exposure, age, vitamin D, and postmenopausal status. METHODOLOGY A cross-sectional study was conducted at Cipto Mangunkusumo General Hospital, Jakarta, involving subjects aged 18-50 years who had been on antiretroviral therapy for at least two years. Bone mineral density was measured using Dual-energy X-ray Absorptiometry at the lumbar spine, total hip, femoral neck, and forearm. Serum 25-hydroxyvitamin D levels were measured using Chemiluminescent Microparticle Immunoassay. Multivariable robust Poisson regression analysis was performed to identify independent risk factors.

Results

A total of 129 subjects were enrolled with a median age of 43 years. The prevalence of low bone mineral density was 20.1% (below the expected range for age 12.4%, osteopenia 5.4%, osteoporosis 2.3%). In the multivariable analysis, factors associated with low bone mineral density were tenofovir disoproxil fumarate exposure >60 months (adjusted prevalence ratio 3.358; p = 0.028), age ≥40 years (adjusted prevalence ratio 3.799; p = 0.049), and postmenopausal status (adjusted prevalence ratio 4.908; p < 0.0001). Vitamin D deficiency and Hepatitis C coinfection were not significantly associated with low bone mineral density.

Conclusions

One in five women living with HIV on stable antiretroviral therapy exhibited low bone mineral density. Tenofovir disoproxil fumarate exposure >60 months, age ≥40 years, and postmenopausal status are significant independent risk factors. Screening for these high-risk groups is recommended.