Endocrine Abstracts

With HAART (Highly Active Anti-Retroviral Therapy) introduction, HIV infection history has radically changed. Increased survival has led to new complications, including osteoporosis. The pathogenesis of osteoporosis in HIV patients is multifactorial: virus, HAART, smoking, alcohol, physical inactivity, comorbidities, and hypogonadism can interact in bone depletion.

Aim of this study was to evaluate the prevalence of osteoporosis, vertebral fractures (VF) and hypogonadism in 189 HIV men. Spine and femoral mineral density (BMD) were acquired by DXA. Vertebral fractures were assessed by quantitative morphometric analysis; VF were defined as mild, moderate and severe based on a height ratio decrease of 20–25%, 26–40% and more than 40%, respectively. For the assessment of gonadal status, total testosterone (TT), calculated free testosterone (cFT), SHBG, LH and FSH values were obtained. Hypogonadism was defined as overt with low TT or cFT levels, and classified in primary, secondary or normogonadotropic based on LH levels. The prevalence of subclinical hypogonadism (TT and cFT normal values, with high LH levels) was assessed. Possible risk factors, and bone turnover markers levels were also collected. Osteoporosis was found in 32.8% of patients (62/189), 30.2% (57/189) showed at least one VF, 11.1% (21/189) had an overt hypogonadism, and 9.5% (18/189) subclinical hypogonadism. Among the patients with overt hypogonadism, 4 showed a primary form, 2 secondary and 12 normogonadotropic. Compared to non-osteoporotic patients, those with osteoporosis had longer infection duration (17.9 vs 13.6 y, P = 0.0034), had been on HAART for more years (14.6 vs 10.9, P = 0.0049), and showed higher SHBG values (78.9 vs 64.5, P = 0.049). With respect to VF, years of HIV-positivity (18.2 vs 13.6, P = 0.0028), HAART duration (14.7 vs 10.9, P = 0.0056), SHBG (84.2 vs 62.7, P = 0.0092) and FSH (12.01 vs 8.21, P = 0.049) values differed significantly between fractured and non-fractured patients. No significant difference was found between hypogonadal and eugonadal patients in terms of BMD (0.954 vs 0.968), vertebral T-score (–1.8 vs −1.5) and VF (29.4% vs 27.2%), whereas it was achieved for BMI (26.3 vs 24.7, P = 0.017) and FSH (15.4 vs 7.7, P <0.001). This study included a large number of HIV+ men in which testicular function was fully assessed, in contrast to most of the published studies. These data show a high prevalence of osteoporosis, VF and hypogonadism in HAART treated HIV-infected men. The role of hypogonadism in osteoporosis and VF pathogenesis is unclear, even if a correlation between FSH and SHBG levels and skeletal fragility was found in these patients.