High rates of untreated osteoporosis found among women in Zimbabwe living with HIV

Despite high rates of untreated osteoporosis and previous fractures among menopausal women in Zimbabwe — especially among those living with HIV — the FRAX® tool predicted a low 10-year major osteoporotic fracture (MOF) risk, suggesting a need to adapt fracture risk prediction tools to better reflect local conditions, according to study results published in the Journal of Bone and Mineral Research.

Information on bone health among menopausal women in East and Southern Africa is limited. Even less data exists regarding women of this cohort living with HIV, despite the fact that the disease disproportionately impacts women in this area. Though it remains invalidated, a newly developed proxy FRAX® tool was calibrated specifically for Zimbabwe, in an attempt to enhance fracture risk assessment.

Researchers conducted a cross-sectional analysis focused on evaluating bone health among women in Zimbabwe both with and without HIV. Women aged from 40 to 60 years living in Harare, Zimbabwe, were recruited via HIV clinics and referrals during the COVID-19 pandemic. Included patients agreed to undergo HIV testing.

The primary outcomes were the occurrence of osteoporosis and prior fractures, as well as the 10-year risk for MOF. Secondary outcomes examined the link between clinical risk factors and bone health indicators.

The final analysis included a total of 393 women (median age, 49 years), of whom 193 (49.1%) were living with HIV. Participants who were HIV-positive had a higher unemployment rate (P <.01) and were less likely to use contraceptives (P <.05). Notably, 95.3% were on antiretroviral therapy for a median duration of 9 years, with 84.8% following a tenofovir disoproxil fumarate-based regimen.

Osteoporosis was most commonly found in the lumbar spine (12.5%) and femoral neck (6.9%), with higher rates among women with vs without HIV: lumbar spine (20.7% vs 4.5%), femoral neck (11.4% vs 2.5%), and total hip (2.6% vs 0%), respectively. A T-score of -2.5 or less was found among 14.8% of women and was more prevalent among those with vs without HIV (24.3% vs 5.5%).

“Despite these findings, no woman had ever been offered any anti-osteoporosis medication,” the researchers noted.

Slightly more than 10% of women reported experiencing past fractures, with a higher incidence among those with (14%) vs without (7%) HIV. Those with previous fragility fractures faced a higher 10-year probability of MOF (2.2% vs 1%), with HIV-positive women at greater, though still low, risk.

Women living with HIV were 2.16 times more likely to have experienced previous fractures. After adjusting for other risk factors, no significant associations were found between age, weight, height, or lifestyle factors and the incidence of prior fractures.

According to results of multivariable analyses, older age (2% increase per year), increasing femoral neck T-scores, a history of parental hip fractures, and prior fractures raised the 10-year probability of MOFs. When considered by itself, HIV infection did not demonstrate an independent link to the 10-year probability of MOF.

Study limitations include the cross-sectional design, possible selection bias, and recall bias from reliance on self-reported fractures.

By Hibah Khaja, PharmD

References:

Madanhire T, Breasail MÓ, Mukwasi-Kahari C, et al. Prevalence of HIV-associated osteoporosis and fracture risk in mid-life women: a cross-sectional study in Zimbabwe. J Bone Miner Res. Published online August 24, 2024. doi:10.1093/jbmr/zjae138