Avaliação da densidade mineral óssea e estimativa de risco de fraturas em homens vivendo com HIV
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2018-12-17
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Universidade Federal de Goiás
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Evaluation of bone mineral density and fracture risk estimation in men living with HIV.
Introduction: HIV carriers are at increased risk of developing chronic noncommunicable diseases at an early age. The reduction of bone mineral density, before the age of 50 years, is described in this population. Few studies evaluate the magnitude of osteoporosis in men with HIV, as well as screening strategies in this segment. Objectives: To estimate the prevalence and to investigate risk factors for changes in bone mineral density (BMD); compare osteoporosis prediction model, with bone-densitometry as the gold standard; to evaluate the risk of fractures using an algorithm in HIV-positive men. Method: Cross-sectional study, population of men with HIV, over 40 years old, using ART, attended in Goiânia-Goiás. Participants answered a standardized questionnaire, performed clinical evaluation and laboratory tests. All investigated bone mineral density through dual energy X-ray absorptiometry (DXA). Osteoporosis was defined as bone mineral density less than / equal to 2.5 standard deviations (SD), considering as a reference a young, healthy population categorized by sex. Osteopenia was defined as a reduction between 1 and 2.4 SD of bone mineral density according to WHO criteria. The Osteoporosis Self-Assessment Tool (which uses weight and age
data) was evaluated in the prediction of osteoporosis and Low BMD. A ROC curve was constructed to assess OST performance. Results: The participants' age ranged from 40 to 72 years, with a mean of 49.6 (SD = 7.5). The prevalence of low bone mineral density was 56.8% (95% CI: 49.25-64, 13%) and osteoporosis 16% (95% CI 11.0 - 22.1). The risk of fractures in 10-years ranged from 1.1% to 20%, with a median of 1.9%. The factors associated with bone density reduction were the use of tenofovir disproxil fumarate and low BMI. The osteoporosis prediction instrument (OST) presented values of area under the curve of 0.71 and 0.67 in the prediction of osteoporosis and low bone mineral density. The cutoff point 7 obtained the best performance in predicting osteoporosis. The instrument revealed low to moderate predictive power over low bone mineral density and osteoporosis compared to DXA. Conclusion: There was a high prevalence of BMD reduction and overweight in a population of relatively young men with HIV.
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SOUSA, C. A. Avaliação da densidade mineral óssea e estimativa de risco de fraturas em homens vivendo com HIV. 2018. 97 f. Tese (Doutorado em Medicina Tropical e Saúde Publica) - Universidade Federal de Goiás, Goiânia, 2018.