Impact of hypogonadism on bone mineral density and vertebral fractures in HIV-infected men

Pezzaioli LC; Porcelli T; Delbarba A; Maffezzoni F; Focà E; Castelli F; Cappelli C; Ferlin A; Quiros-Roldan ME

doi:10.1007/s40618-021-01665-7

Bone Health Hormones and Bone

Impact of hypogonadism on bone mineral density and vertebral fractures in HIV-infected men

Pezzaioli LC, Porcelli T, Delbarba A, Maffezzoni F, Focà E, Castelli F, Cappelli C, Ferlin A, Quiros-Roldan ME

Published February 2022 Journal of endocrinological investigation

DOI 10.1007/s40618-021-01665-7 PMID 34460073 PMC PMC8783890

RRM Academy Synopsis

Hypogonadism is more common in men with HIV and vertebral fractures

A study of 168 men with HIV found men with spine fractures were more often hypogonadal than men without them. Bone loss was common, and about 1 out of 4 of the men had a spine fracture. All were on antiretroviral therapy.

Key Findings

Of 168 men (median age 53), 21 (12.5%) had normal bone density, 89 (53.0%) had osteopenia and 58 (34.5%) had osteoporosis.
Vertebral fractures were found in 42 of 168 men (25.0%). Hypogonadism was diagnosed in 44 of 168 (26.2%), and 21 of those 44 had overt hypogonadism.
Men with vertebral fractures were more often hypogonadal (p = 0.044) and had higher Sex Hormone Binding Globulin (SHBG) (p = 0.010) than men without fractures.
In the fracture model, older age (OR 1.12, 95% CI 1.02–1.23) and higher SHBG (OR 1.08, 95% CI 1.01–1.16) predicted vertebral fractures.
The adjusted analysis of spine bone density found no significant correlation.

Interpretation

This cohort study followed 168 men with HIV on antiretroviral therapy. Vertebral fractures were linked with hypogonadism and with higher SHBG levels. Gonadal hormone status tracked fracture risk more closely than bone density did. The findings support larger studies of hormone health and bone health in men with HIV.

RRM Context

Restorative reproductive medicine evaluates both partners, including a man's hormone health. Hypogonadism means the testis makes too little testosterone. This study links it to weaker bones in men with HIV.

Our editorial summary of this paper, not the article's abstract.

Abstract

Purpose

Hypogonadism and osteoporosis are frequently reported in HIV-infected men and, besides multifactorial pathogenesis, they might be directly linked because of testicular involvement in bone health. We evaluated the prevalence of osteoporosis and vertebral fractures (VFs) in HIV-infected men, and assessed their relationship with gonadal function.

Methods

We enrolled 168 HIV-infected men (median age 53). Osteoporosis and osteopenia were defined with T-score ≤ - 2.5SD and T-score between - 1 and - 2.5SD, respectively. VFs were assessed by quantitative morphometric analysis. Total testosterone (TT), calculated free testosterone (cFT), Sex Hormone Binding Globulin (SHBG), Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH) were obtained; overt hypogonadism was defined on symptoms and low TT or cFT, and classified into primary and secondary according to gonadotropins; compensated hypogonadism was defined as normal TT and cFT with high LH levels.

Results

Overall, osteoporosis and osteopenia were found in 87.5% of patients, and VFs were detected in 25% of them; hypogonadism was identified in 26.2% of cases. Osteoporotic patients had higher SHBG vs those with normal bone mineral density (BMD). Fractured patients were more frequently hypogonadal and with higher SHBG. SHBG showed negative correlation with both spine and femoral BMD, and positive correlation with VFs. In multivariate models, FSH showed negative impact only on femoral BMD, whereas older age and higher SHBG predicted VFs.

Conclusion

We found a high burden of bone disease and hypogonadism in HIV-infected men, and we showed that the impact of gonadal function on bone health is more evident on VFs than on BMD.

Topics

Bone Health

Hormones and Bone Estrogen and Bone

Bone Health › Hormones and Bone › Estrogen and Bone

PMID 34460073 34460073 DOI 10.1007/s40618-021-01665-7 10.1007/s40618-021-01665-7 Pezzaioli et al. 2022, Pezzaioli 2022

Impact of hypogonadism on bone mineral density and vertebral fractures in HIV-infected men

Hypogonadism is more common in men with HIV and vertebral fractures

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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