The impact of human immunodeficiency virus and menopause on bone mineral density: a longitudinal study of urban-dwelling South African women
The impact of human immunodeficiency virus and menopause on bone mineral density: a longitudinal study of urban-dwelling South African women
An estimated 25% of South African women live with human immunodeficiency virus (HIV). Antiretroviral therapy roll-out has improved life expectancy, so many more women now reach menopause. We aimed to quantify changes in bone mineral density (BMD) during the menopausal transition in urban-dwelling South African women with and without HIV and determine whether HIV infection modified the effect of menopause on BMD changes. A 5-year population-based longitudinal study recruited women aged 40–60 years residing in Soweto and collected demographic and clinical data, including HIV status, anthropometry, and BMD, at baseline and at 5-year follow-up. All women were staged as pre-, peri-, or postmenopausal at both time points. Multivariable linear regression assessed relationships and interactions between HIV infection, menopause, and change in BMD. At baseline, 450 women had mean age 49.5 (SD 5.7) years, 65 (14.4%) had HIV, and 140 (31.1%), 119 (26.4%), and 191 (42.4%) were pre-, peri-, and postmenopausal, respectively; 34/205 (13.6%) women ≥50 years had a total hip (TH) or lumbar spine (LS) T-score ≤ −2.5. At follow-up 38 (8.4%), 84 (18.7%), and 328 (72.9%) were pre-, peri-, and postmenopausal. Those with HIV at baseline lost more total body (TB) BMD (mean difference −0.013 [95% confidence interval −0.026, −0.001] g/cm
2, p = 0.040) and gained more weight 1.96 [0.32, 3.60] kg; p = 0.019 than HIV-uninfected women. After adjusting for age, baseline weight, weight change, and follow-up time, the transition from pre- to postmenopause was associated with greater TB BMD losses in women with HIV (−0.092 [−0.042, −0.142] g/cm
2; p = 0.001) than without HIV (−0.038 [−0.016, −0.060] g/cm
2, p = 0.001; interaction p = 0.034). Similarly, in women who were postmenopausal at both time points, those with HIV lost more TB BMD (−0.070 [−0.031, −0.108], p = 0.001) than women without HIV (−0.036 [−0.015, −0.057], p = 0.001, interaction p = 0.049). Findings were consistent but weaker at the LS and TH. Menopause-related bone loss is greater in women with HIV, suggesting women with HIV may be at greater risk of osteoporotic fractures. HIV services should consider routine bone health assessment in midlife women as part of long-term HIV care delivery.
BONE MINERAL DENSITY, DUAL-ENERGY X-RAY ABSORPTIOMETRY, HUMAN IMMUNODEFICIENCY VIRUS, MENOPAUSE, SOUTH AFRICA
619-630
Madanhire, Tafadzwa
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Goedecke, Julia H.
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Ward, Kate A.
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Jaff, Nicole
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Crowther, Nigel J.
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Norris, Shane
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Ferrand, Rashida A.
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Rehman, Andrea M.
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Micklesfield, Lisa K.
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Gregson, Celia L.
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May 2023
Madanhire, Tafadzwa
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Goedecke, Julia H.
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Ward, Kate A.
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Jaff, Nicole
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Crowther, Nigel J.
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Norris, Shane
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Ferrand, Rashida A.
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Rehman, Andrea M.
70df2a8e-aa95-4942-ad10-4644280f13bf
Micklesfield, Lisa K.
e73dd95b-ce79-4dc4-b0be-a8935eb069c8
Gregson, Celia L.
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Madanhire, Tafadzwa, Goedecke, Julia H., Ward, Kate A., Jaff, Nicole, Crowther, Nigel J., Norris, Shane, Ferrand, Rashida A., Rehman, Andrea M., Micklesfield, Lisa K. and Gregson, Celia L.
(2023)
The impact of human immunodeficiency virus and menopause on bone mineral density: a longitudinal study of urban-dwelling South African women.
Journal of Bone and Mineral Research, 38 (5), .
(doi:10.1002/jbmr.4765).
Abstract
An estimated 25% of South African women live with human immunodeficiency virus (HIV). Antiretroviral therapy roll-out has improved life expectancy, so many more women now reach menopause. We aimed to quantify changes in bone mineral density (BMD) during the menopausal transition in urban-dwelling South African women with and without HIV and determine whether HIV infection modified the effect of menopause on BMD changes. A 5-year population-based longitudinal study recruited women aged 40–60 years residing in Soweto and collected demographic and clinical data, including HIV status, anthropometry, and BMD, at baseline and at 5-year follow-up. All women were staged as pre-, peri-, or postmenopausal at both time points. Multivariable linear regression assessed relationships and interactions between HIV infection, menopause, and change in BMD. At baseline, 450 women had mean age 49.5 (SD 5.7) years, 65 (14.4%) had HIV, and 140 (31.1%), 119 (26.4%), and 191 (42.4%) were pre-, peri-, and postmenopausal, respectively; 34/205 (13.6%) women ≥50 years had a total hip (TH) or lumbar spine (LS) T-score ≤ −2.5. At follow-up 38 (8.4%), 84 (18.7%), and 328 (72.9%) were pre-, peri-, and postmenopausal. Those with HIV at baseline lost more total body (TB) BMD (mean difference −0.013 [95% confidence interval −0.026, −0.001] g/cm
2, p = 0.040) and gained more weight 1.96 [0.32, 3.60] kg; p = 0.019 than HIV-uninfected women. After adjusting for age, baseline weight, weight change, and follow-up time, the transition from pre- to postmenopause was associated with greater TB BMD losses in women with HIV (−0.092 [−0.042, −0.142] g/cm
2; p = 0.001) than without HIV (−0.038 [−0.016, −0.060] g/cm
2, p = 0.001; interaction p = 0.034). Similarly, in women who were postmenopausal at both time points, those with HIV lost more TB BMD (−0.070 [−0.031, −0.108], p = 0.001) than women without HIV (−0.036 [−0.015, −0.057], p = 0.001, interaction p = 0.049). Findings were consistent but weaker at the LS and TH. Menopause-related bone loss is greater in women with HIV, suggesting women with HIV may be at greater risk of osteoporotic fractures. HIV services should consider routine bone health assessment in midlife women as part of long-term HIV care delivery.
Text
J of Bone Mineral Res - 2023 - Madanhire - The Impact of Human Immunodeficiency Virus and Menopause on Bone Mineral
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More information
Accepted/In Press date: 29 December 2022
e-pub ahead of print date: 1 February 2023
Published date: May 2023
Additional Information:
Funding Information:
The study received funding from the South African Medical Research Council, with funds received from the South African National Department of Health, the UK Medical Research Council, the Newton Fund, GSK (Grant ES/N013891/1), and South African National Research Foundation (Grant UID:98561). This work was funded by the University of Bristol QR Global Challenges Research Funding (ref: H100004‐135). Rashida A. Ferrand is funded by the Wellcome Trust (206316/Z/17/Z).
Publisher Copyright:
© 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Keywords:
BONE MINERAL DENSITY, DUAL-ENERGY X-RAY ABSORPTIOMETRY, HUMAN IMMUNODEFICIENCY VIRUS, MENOPAUSE, SOUTH AFRICA
Identifiers
Local EPrints ID: 475187
URI: http://eprints.soton.ac.uk/id/eprint/475187
ISSN: 0884-0431
PURE UUID: 089e24f2-aa0d-4ff1-8bc5-340d92f537d5
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Date deposited: 13 Mar 2023 17:52
Last modified: 17 Mar 2024 03:57
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Contributors
Author:
Tafadzwa Madanhire
Author:
Julia H. Goedecke
Author:
Nicole Jaff
Author:
Nigel J. Crowther
Author:
Rashida A. Ferrand
Author:
Andrea M. Rehman
Author:
Lisa K. Micklesfield
Author:
Celia L. Gregson
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