Changes in calciotropic hormones and biochemical markers of bone metabolism in patients with human immunodeficiency virus infection

Data on the bone metabolism of human immunodeficiency virus (HIV)-infected patients are still extremely rare. To investigate the influence of HIV infe ction on the calciotropic hormones and markers of bone metabolism, we there fore performed a cross-sectional study on 100 patients (65 males and 35 fem ales) with proven HIV infection. The following criteria were used for exclu sion from the study: age less than 20/more than 50 years, confinement to be d, wasting symptoms, treatment with agents containing ketoconazole, renal o r hepatic insufficiency, clinical or echographic signs of liver cirrhosis, endocrine diseases, or treatment with medications known to influence bone m etabolism. Bone mineral content (BMC) was determined by single-photon absor ptiometry on the left forearm. Reduced BMC was found among the male and fem ale HIV-infected patients. Additional long-term use of heroin resulted in a severe loss of mineralization in the respective females. The markers of bo ne metabolism were determined in urine and serum samples. Significantly low er osteocalcin concentrations were found, indicating a reduced bone formati on rate whose severity showed a significant correlation with the progressiv e loss of CD4 helper cells and was independent of low vitamin D-3 levels (1 ,25-dihydroxycholecalciferol) and alterations of protein metabolism. Increa sed urinary excretion of cross-links as an expression of enhanced bone reso rption was likewise significantly correlated with the loss of CD4 helper ce lls and independent of the vitamin D concentration and protein metabolism. It is therefore concluded that the changes in bone metabolism are mainly du e to mechanisms of the impaired immune defense of HIV-infected patients. Co pyright (C) 2000 by W.B. Saunders Company.