What question did this study set out to answer?

To investigate sex-specific bone architectural deficits in older adults with HIV in Zimbabwe.

May 14, 2026Journal of Bone and Mineral Research0 citationsOpen Access

Sex-specific bone architectural deficits among older adults living with HIV: a cross-sectional study from Zimbabwe

MBMícheál Ó BreasailMonash Medical Centre KWKate A WardMRC Unit the Gambia TMTadios ManyangaBiomedical Research and Training Institute

Key Points

To investigate sex-specific bone architectural deficits in older adults with HIV in Zimbabwe.
Cross-sectional study of adults ≥40 years in Harare, Zimbabwe (N=1101).
Data collected on sociodemographics, HIV status, and pQCT measurements.
Linear regression analyses adjusted for age, wealth-index, height, and weight were conducted.
Men with HIV showed a 7.1% reduction in radial total vBMD compared to HIV-negative men (p<0.01).
Women with HIV exhibited a 1.4% reduction in cortical vBMD and a 7.2% decrease in cortical thickness (p<0.01).
Years since HIV diagnosis correlated with significant decreases in bone density metrics, including 1.9% reduction in radius total vBMD per year for women.

Abstract

Abstract People with HIV (PLWH) are living longer with antiretroviral therapy (ART) but HIV increases the risk of age-associated diseases including osteoporosis. A cross-sectional study of men and women ≥40 years was conducted in Harare, Zimbabwe. Sociodemographic data, HIV status/treatment, and anthropometry were collected. Outcomes were peripheral quantitative computed tomography (pQCT): total volumetric bone mineral density v(BMD), trabecular vBMD, cross-sectional area (CSA), compressive bone strength (BSIc), cortical vBMD, cortical thickness, proximal CSA, and polar stress-strain index (pSSI). Sex-stratified linear regression determined differences by HIV status, minimally adjusted for age and wealth-index (WI), and further adjusted for height and weight. Linear regression adjusted for age and WI assessed associations between HIV- and ART-duration, TDF-use, and viral suppression on bone. 1101 participants (PLWH 20.3%; Male 48.6%), aged mean(SD) 62.4(14.1) years, had pQCT data. HIV-related bone impairments, robust to full adjustment for age, wealth-index, height, and weight were observed. Men with HIV (MLWH) had lower radial total vBMD (-7.1% -10.9;-3.2%), trabecular vBMD (-11.3% -16.9%;-5.6%), and BSIc (-12.0% -18.7%;-5.4%) than HIV-negative men. Trabecular findings were similar in women with HIV (WLWH), plus lower cortical vBMD (-1.4 -2.3;-0.6%) and thickness (-7.2 -11.1;-3.3% were also seen. Tibial pQCT findings were broadly consistent. In WLWH , years since HIV-diagnosis were associated with lower radius total vBMD (-1.9% per-year -3.2%;-0.6%), trabecular vBMD (-4.2% -6.5%;-2.0%), BSIc (-3.9% -6.2%;-1.6%), cortical vBMD (-0.3% -0.6%;-0.1%), and thickness (-1.6% -2.7%;-0.5%). In MLWH, years since HIV-diagnosis were associated with smaller proximal tibia CSA (-1.0% -1.9%;-0.2%) and TDF-use with lower tibia cortical vBMD (-1.4% -2.8%; -0.1%). Older Zimbabwean PLWH have markedly lower trabecular vBMD compared to HIV-negative peers additional cortical compartment impairments were evident in women. These data add to the growing evidence that women with HIV in particular may be at increased risk of age-associated osteoporotic fragility fracture relatively early in their life-course.

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