Reduced bone density in androgen-deficient women with acquired immune deficiency syndrome wasting

Women with acquired immune deficiency syndrome wasting are at an increased risk of osteopenia because of low weight, changes in body composition, and hormonal alterations. Although women comprise an increasing proportion of h uman immunodeficiency virus-infected patients, prior studies have not inves tigated bone loss in this expanding population of patients. In this study w e investigated bone density, bone turnover, and hormonal parameters in 28 w omen with acquired immune deficiency syndrome wasting and relative androgen deficiency (defined as free testosterone less than or equal to3.0 pg/ml, w eight less than or equal to 90% ideal body weight, weight loss greater than or equal to 10% from pre-illness maximum weight, or weight < 100% ideal bo dy weight with weight loss greater than or equal to5% from preillness maxim um weight). Total body (1.04 +/- 0.08 vs. 1.10 +/- 0.07 g/cm(2), human immu nodeficiency virus-infected vs. control respectively; P < 0.01), anteropost erior lumbar spine (0.94 +/- 0. 12 vs. 1.03 +/- 0.09 g/cm(2); P = 0.005), l ateral lumbar spine (0.71 +/- 0.14 vs. 0.79 +/- 0.09 g/cm(2); P = 0.02), an d hip (Ward's triangle; 0.68 +/- 0.14 vs. 0.76 +/- 0.12 g/cm(2); P = 0.05) bone density were reduced in the human immunodeficiency virus-infected comp ared with control subjects. Serum N-telopeptide, a measure of bone resorpti on, was increased in human immunodeficiency virus-infected patients, compar ed with control subjects (14.6 +/- 5.8 vs. 11.3 +/- 3.8 nmol/liter bone col lagen equivalents, human immunodeficiency virus-infected vs. control respec tively; P = 0.03). Although body mass index was similar between the groups, muscle mass was significantly reduced in the human immunodeficiency virus- infected vs. control subjects (16 +/- 4 vs. 21 +/- 4 kg, human immunodefici ency virus-infected vs. control, respectively; P < 0.0001). In univariate r egression analysis, muscle mass (r = 0.53; P = 0.004) and estrogen (r = 0.5 1; P = 0.008), but not free testosterone (r = -0.05, P = 0.81), were strong ly associated with lumbar spine bone density in the human immunodeficiency virus-infected patients. The association between muscle mass and bone densi ty remained significant, controlling for body mass index, hormonal status, and age (P = 0.048) in multivariate regression analysis. These data indicate that both hormonal and body composition factors contrib ute to reduced bone density in women with acquired immune deficiency syndro me wasting. Anabolic strategies to increase muscle mass may be useful to in crease bone density among osteopenic women with acquired immune deficiency syndrome wasting.