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.

中文翻译：

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性腺功能减退对 HIV 感染男性骨矿物质密度和椎骨骨折的影响

目的

HIV 感染男性中经常报告性腺功能减退和骨质疏松症，除了多因素发病机制外，由于睾丸参与骨骼健康，它们可能直接相关。我们评估了 HIV 感染男性中骨质疏松症和椎骨骨折 (VFs) 的患病率，并评估了它们与性腺功能的关系。

方法

我们招募了 168 名 HIV 感染男性（中位年龄 53 岁）。骨质疏松症和骨质减少症的定义分别为 T 分数 ≤ – 2.5SD 和 T 分数介于 – 1 和 – 2.5SD 之间。通过定量形态分析评估VF。获得总睾酮（TT）、计算的游离睾酮（cFT）、性激素结合球蛋白（SHBG）、促黄体激素（LH）和促卵泡激素（FSH）；明显的性腺功能减退症以症状和低TT或cFT为特征，根据促性腺激素分为原发性和继发性；代偿性性腺功能减退症被定义为正常的 TT 和 cFT 具有高 LH 水平。

结果

总体而言，87.5% 的患者出现骨质疏松和骨质减少，其中 25% 的患者检测到 VF；在 26.2% 的病例中发现了性腺机能减退。与骨矿物质密度 (BMD) 正常的患者相比，骨质疏松症患者的 SHBG 更高。骨折患者更常出现性腺功能减退和更高的 SHBG。SHBG与脊柱和股骨BMD呈负相关，与VF呈正相关。在多变量模型中，FSH 仅对股骨 BMD 显示出负面影响，而年龄较大和较高的 SHBG 可预测 VF。

结论

我们发现感染 HIV 的男性患有骨病和性腺功能减退的高负担，并且我们发现性腺功能对骨骼健康的影响在 VF 上比在 BMD 上更明显。