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Bone mineral density (BMD) in a population of healthy HIV-negative young African adults enrolling in a pre-exposure prophylaxis (PrEP) trial in Botswana
Presented by Michael Craig Thigpen (Botswana), Lynn Paxton (United States).
E. Buliva1, C. Vite San Pedro1, R. Mutanhaurwa1, P. Kebaabetswe1, E. Jooste2, S. Johnson1, T. Sukalac1, L. Paxton3, M.C. Thigpen1,3
1BOTUSA, HIV Prevention Research Division, Gaborone, Botswana, 2Medical Imaging Botswana, Gaborone, Botswana, 3Centers for Disease Control and Prevention (CDC), Division of HIV/AIDS Prevention, Epidemiology Branch, Atlanta, United States
Background: Very limited data exist on BMD in healthy, HIV-negative African populations. Baseline data on bone health are important as tenofovir-containing regimens, which can reduce BMD, may potentially be used for HIV prevention should PrEP be proven efficacious.
Methods: We performed baseline Dual Emission X-Ray Absorptiometry and calculated T-Score values on a subset of HIV-negative young adults in Gaborone, Botswana enrolling in a clinical trial evaluating the efficacy of tenofovir/emtricitabine in preventing HIV infection. We used toxicity tables from the U.S. National Institutes of Health's Division of AIDS to define low BMD as either osteopenia (-1≥Total T-Score≥-2.5) or osteoporosis (Total T-score< -2.5) of the wrist, hip or lumbar spine (L-spine). We provided all participants with low BMD with calcium and vitamin D supplements.
Results: Among 102 males and 114 females in this sub-study, the mean age was 24 years (range 20-29 years); all were black Batswana. Low BMD in ≥1 anatomic site was noted in 123 (57%) participants; 19.0% and 4.2% had low BMD in two and three sites respectively. (Table)
Proportion of Participants with Osteopenia or Osteoporosis Stratified by Gender, Age, Body Mass Index, and Anatomic Site
| | Gender | Age | Body Mass Index (BMI) | | | Female
n=114 | Male
n=102 | 20-24 years
n=124 | 25-29 years
n=92 | Underweight (BMI<18.5)
n=39 | Normal
(BMI 18.5-24.9)
n=138 | Overweight (BMI≥25)
n=39 | | Wrist
osteopenia
osteoporosis |
21.9%
0.0% |
50.0%
3.9% |
41.1%
1.6% |
27.2%
2.1% |
48.7%
5.1% |
35.5%
1.4% |
20.5%
0.0% | | Hip
osteopenia
osteoporosis |
8.8%
0.0% |
4.9%
0.0% |
6.5%
0.0% |
7.6%
0.0% |
15.4%
0.0% |
6.5%
0.0% |
0.0%
0.0% | | L-spine
osteopenia
osteoporosis |
38.6%
0.9% |
40.2%
1.0% |
41.9%
1.6% |
35.9%
0.0% |
25.6%
2.6% |
47.8%
0.7% |
23.1%
0.0% |
Conclusions: Osteopenia in this group of HIV-negative young adults is very common. As tenofovir-containing regimens are used more frequently for HIV treatment and potentially prevention, further population-based studies (including assessment of nutritional status and alcohol use) are needed to determine the prevalence of low BMD in both HIV-positive and HIV-negative African populations.
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