PURPOSE In adults with long-term HIV infection, low bone density and increased fracture risk have emerged as significant comorbidities. Our aim was to assess the association of exercise, nutrition, and medications with bone quality in adults with long-term HIV infection. METHODS Forty-three adults with HIV infection were enrolled (median BMI 25.7, range 18.2-35.6 kg/m2; median age 57, range 50-69 years). Participants underwent ultradistal radius and tibia high-resolution peripheral quantitative CT (HR-pQCT). Questionnaires included the revised Community Healthy Activities Model Program for Seniors (CHAMPS), the Mini Nutritional Assessment (MNA) as well as medication assessments. Multivariable linear regression models were used to evaluate the association of exercise, nutritional status, tenofovir disoproxil fumarate (TDF) and protease inhibitor (PI) use with bone density and microstructure, adjusting for demographic risk factors. RESULTS In regression models, higher nutrition scores were associated with higher tibia cortical thickness (R2 = 0.23; β = 0.03; p = 0.044) and higher radius cortical BMD (R2 = 0.43; β = 8.4; p = 0.026). Higher weekly frequency of all physical activities was significantly associated with higher radius trabecular BMD (R2 = 0.38; β = 0.96; p = 0.050), higher radius trabecular number (R2 = 0.31; β = 0.01; p = 0.026), lower tibia and radius trabecular separation (tibia: R2 = 0.30; β = -0.003; p = 0.038; radius: R2 = 0.35; β = -0.003; p = 0.021), and higher radius bone stiffness (R2 = 0.45; β = 0.38; p = 0.047). Higher frequency of bone loading physical activities was significantly associated with higher tibia trabecular density (R2 = 0.44; β = 4.06; p = 0.036), higher tibia bone stiffness (R2 = 0.46; β = 3.06; p = 0.050), and higher tibia estimated failure load (R2 = 0.46; β = 0.17; p = 0.049). TDF used in combination with a PI was associated with lower radius trabecular BMD (R2 = 0.39; β = -41.2; p = 0.042), lower radius trabecular number (R2 = 0.34; β = -0.44; p = 0.009) and greater radius trabecular separation (R2 = 0.42; β = 0.16; p = 0.002), while TDF use without a PI was not associated with reduced bone quality. CONCLUSIONS In adults with HIV infection, malnutrition is associated with poor cortical bone quality, while reduced frequency of physical activities and specifically reduced frequency of mechanical loading activities are associated with deficient trabecular bone structure and reduced estimates of bone strength. TDF use in combination with a PI is associated with deleterious effects on trabecular bone structure.

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通过 HR-pQCT 评估长期 HIV 感染者骨微结构改变的相关因素

目的 在长期感染 HIV 的成年人中，骨密度低和骨折风险增加已成为重要的合并症。我们的目的是评估运动、营养和药物与长期感染 HIV 的成年人的骨骼质量之间的关系。方法 43 名感染 HIV 的成年人被纳入研究（中位 BMI 25.7，范围 18.2-35.6 kg/m2；中位年龄 57，范围 50-69 岁）。参与者接受了超远端桡骨和胫骨高分辨率外周定量 CT (HR-pQCT)。调查问卷包括修订后的老年人社区健康活动模型计划 (CHAMPS)、迷你营养评估 (MNA) 以及药物评估。多变量线性回归模型用于评估运动、营养状况、富马酸替诺福韦二吡呋酯 (TDF) 和蛋白酶抑制剂 (PI) 使用骨密度和微观结构，调整人口学风险因素。结果 在回归模型中，较高的营养评分与较高的胫骨皮质厚度（R2 = 0.23；β = 0.03；p = 0.044）和较高的桡骨皮质骨密度（R2 = 0.43；β = 8.4；p = 0.026）相关。所有身体活动的每周频率较高与较高的桡骨小梁 BMD（R2 = 0.38；β = 0.96；p = 0.050）、较高的桡骨小梁数量（R2 = 0.31；β = 0.01；p = 0.026）、较低的胫骨和桡骨小梁分离（胫骨：R2 = 0.30；β = -0.003；p = 0.038；桡骨：R2 = 0.35；β = -0.003；p = 0.021）和更高的桡骨骨刚度（R2 = 0.45；β = 0.38；p = 0.047）。较高频率的骨骼负荷体育活动与较高的胫骨小梁密度（R2 = 0.44；β = 4.06；p = 0.036）、较高的胫骨骨刚度（R2 = 0.46；β = 3.06；p = 0.050）和较高的胫骨显着相关估计失效载荷（R2 = 0.46；β = 0.17；p = 0.049）。TDF 与 PI 联合使用与小骨小梁 BMD（R2 = 0.39；β = -41.2；p = 0.042）、小骨小梁数目小（R2 = 0.34；β = -0.44；p = 0.009）和大半径相关小梁分离（R2 = 0.42；β = 0.16；p = 0.002），而在没有 PI 的情况下使用 TDF 与骨质量下降无关。结论 在感染 HIV 的成年人中，营养不良与皮质骨质量差有关，而减少身体活动的频率，特别是减少机械负荷活动的频率，与骨小梁结构缺陷和骨强度估计值降低有关。TDF 与 PI 结合使用会对小梁骨结构产生有害影响。