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Bone turnover and bone mineral density in HIV-1 infected Chinese taking highly active antiretroviral therapy –a prospective observational study

Lixia Zhang1, Yuanbo Su1, Evelyn Hsieh1, Weibo Xia2, Jing Xie1, Yang Han1, Ying Cao1, Yanling Li1, Xiaojing Song1, Ting Zhu1, Taisheng Li1* and Wei Yu3*

Author Affiliations

1 Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medicine Science, Beijing, China

2 Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medicine Science, Beijing, China

3 Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medicine Science, Beijing, China

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BMC Musculoskeletal Disorders 2013, 14:224  doi:10.1186/1471-2474-14-224

Published: 30 July 2013



Low bone mass and high bone turnover have been reported in HIV-infected individuals, both as a consequence of HIV infection itself, as well as from treatment with highly active antiretroviral therapy (HAART). The purpose of this study is to evaluate the impact of HAART on bone mineral density and bone turnover in HIV-1 infected Chinese patients.


Forty HIV-1 infected patients were enrolled in this study; all patients were followed through 48 weeks, and 17 patients completed 96 weeks. Bone mineral density (BMD), procollagen type 1 N-terminal propeptide (P1NP), collagen type 1 cross-linked C-telopeptide (β-CTX), parathyroid hormone (PTH), and 25-OH vitamin D levels were measured at baseline, 48 and 96 weeks. Baseline measurements were compared with an age-, gender-, and BMI-matched healthy control population.


At baseline, raw BMD in the lumbar spine of HIV-1 infected patients was significantly lower than that of healthy controls (1.138 ± 0.112 g/cm2 vs. 1.195 ± 0.139 g/cm2, p = 0.047). During the first 48 weeks after initiating HAART, BMD of lumbar spine, femoral neck, and total hip decreased significantly in HIV-1 infected patients, with annual percent decline ranging from 1.78-3.28%. However, from week 48 to 96, BMD remained stable. Baseline levels of β-CTX (0.31 ± 0.16 ng/mL vs. 0.42 ± 0.19 ng/mL, p = 0.008) and P1NP (32.96 ± 14.00 ng/mL vs. 55.82 ± 26.87 ng/mL, p = 0.05) were lower in HIV-infected patients compared with controls, respectively. Both β-CTX and P1NP levels increased after onset of HAART until week 48, and remained elevated during the next 48 weeks. 25-OH vitamin D in HIV-infected patients was lower at baseline compared to healthy controls, but this difference was not statistically significant. PTH, however, was higher in HIV patients at baseline, and showed a significant increase throughout the study.


Chinese adults with HIV-1 infection have low bone turnover prior to HAART as well as lower raw BMD of the lumbar spine compared with healthy controls, with further bone loss occurring following the initiation of HAART. The long-term clinical implications of these findings remain unclear at this time.

Acquired immunodeficiency syndrome (AIDS); Bone mineral density (BMD); Bone turnover marker (BTM); Highly active antiretroviral therapy (HAART)