The impact of Human Immuno Deficiency Virus and menopause on bone mineral density: a longitudinal study of urban-dwelling South African women

Abstract

An estimated 25% of South African women live with human immunodeficiency virus (HIV). Antiretroviral therapy roll-out has improved lifeexpectancy, so many more women now reach menopause. We aimed to quantify changes in bone mineral density (BMD) during the men-opausal transition in urban-dwelling South African women with and without HIV and determine whether HIV infection modified the effect ofmenopause on BMD changes. A 5-year population-based longitudinal study recruited women aged 40–60 years residing in Soweto and col-lected demographic and clinical data, including HIV status, anthropometry, and BMD, at baseline and at 5-year follow-up. All women werestaged as pre-, peri-, or postmenopausal at both time points. Multivariable linear regression assessed relationships and interactions betweenHIV infection, menopause, and change in BMD. At baseline, 450 women had mean age 49.5 (SD 5.7) years, 65 (14.4%) had HIV, and140 (31.1%), 119 (26.4%), and 191 (42.4%) were pre-, peri-, and postmenopausal, respectively; 34/205 (13.6%) women ≥50 years had a totalhip (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. Thosewith HIV at baseline lost more total body (TB) BMD (mean difference 0.013 [95% confidence interval 0.026, 0.001] g/cm2, p = 0.040) andgained more weight 1.96 [0.32, 3.60] kg; p = 0.019 than HIV-uninfected women. After adjusting for age, baseline weight, weight change, andfollow-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/cm2; p = 0.001) than without HIV ( 0.038 [ 0.016, 0.060] g/cm2, p = 0.001; interaction p = 0.034). Similarly, in women who werepostmenopausal 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 boneloss is greater in women with HIV, suggesting women with HIV may be at greater risk of osteoporotic fractures. HIV services should considerroutine bone health assessment in midlife women as part of long-term HIV care delivery. © 2023 The Authors. Journal of Bone and MineralResearch published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).