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Low Body Weight Mediates the Relationship between HIV Infection and Low Bone Mineral Density: A Meta-Analysis

Department of Medicine, University of Auckland, Auckland, New Zealand

Address all correspondence and requests for reprints to: Mark Bolland, Osteoporosis Research Group, Department of Medicine, University of Auckland, Private Bag 92 019, Auckland, New Zealand. E-mail: m.bolland{at}auckland.ac.nz.

Context: HIV infection has been associated with low bone mineral density (BMD) in many cross-sectional studies, although longitudinal studies have not demonstrated accelerated bone loss. The cross-sectional studies may have been confounded by the failure to control for low body weight in HIV-infected patients.

Objective: Our objective was to determine whether low body weight might explain the association of HIV infection with low BMD.

Data Sources: MEDLINE and EMBASE were searched for English language studies published from 1966 to March 2007, and conference abstracts prior to 2007 were hand-searched.

Study Selection: All studies reporting BMD and weight or body mass index in adult patients with HIV and a healthy age- and sex-comparable control group were included. Nine of 40 identified studies and one of 68 identified abstracts were eligible.

Data Synthesis: We adjusted for the between-groups weight differences using regression coefficients from published cohorts of healthy men and women. On average, HIV-infected patients were 5.1 kg [95% confidence interval (CI), –6.8, –3.4; P < 0.001] lighter than controls. At all skeletal sites, unadjusted BMD was lower by 4.4–7.0% in the HIV-infected groups than the controls (P < 0.01). After adjustment for body weight, residual between-groups differences in BMD were small (2.2–4.7%) [lumbar spine, –0.02 (95% CI, –0.05, 0.01) g/cm²; P = 0.12; total hip, –0.02 (95% CI, –0.04, 0.00) g/cm²; P = 0.031; femoral neck, –0.04 (95% CI, –0.07, –0.01) g/cm²; P = 0.013; and total body, –0.03 (95% CI, –0.07, 0.01) g/cm², P = 0.11].

Conclusion: HIV-infected patients are lighter than controls and low body weight may largely account for the high prevalence of low BMD reported in HIV-infected patients. However, in the setting of current treatment practice, HIV infection per se is not a risk factor for low BMD.

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