110 - Bone Mineral Density Screening in Veterans Living with HIV

Background: Low bone mineral density (BMD) is more prevalent in people living with HIV (PLWH) than in the general population. Although no consensus exists regarding when to start screening for BMD loss in PLWH, the Infectious Diseases Society of America (IDSA) recommends dual x-ray absorptiometry (DXA) for men aged ≥50 years, postmenopausal women, and patients with a history of fragility fracture, chronic glucocorticoid treatment, or at high fall risk. The objective of this study is to evaluate how well this guideline is being carried out in a population of veterans living with HIV (VLWH).

Methods: We retrospectively identified VLWH seen at the Veterans Affairs Medical Center (VAMC) in Houston, TX, between 2014-2018 via the VAMC HIV Registry. We extracted demographic, laboratory, and clinical variables, as well as DXA results via this registry database and subsequent chart review.

Results: We identified 1,306 VLWH who received care between 2014-2018; 197 turned 50 years old during this time period. Of those, only 32 (16.2%) underwent DXA (2 women, 30 men). DXA revealed normal BMD in 17 (53.1%), osteopenia in 12 (37.5%), and osteoporosis in 3 (9.4%), as defined by traditional DXA T-score cutoffs. Average CD4 count at time of DXA was 698 cells/mm³ (n=30) (average CD4 for those with normal DXA was 654 [n=16] and for those with osteopenia/osteoporosis it was 749 [n=14]; t-test p = 0.47). Thirty had HIV viral load (VL) < 100 copies/mL; the remaining 2 had VLs of 11,200 and 2,980, both with normal DXAs. Vitamin D (VD) levels were available for 1,005 (77%) VLWH in the study cohort. Of those, 278 (27.7%) were VD deficient (25-hydroxy VD level of < 20 ng/mL). VD levels were available for 31 of the 32 VLWH who had DXA after turning 50 years old; the average VD level was 22.76 (24.61 [n=16] for those with normal BMD and 20.78 [n=15] for those with osteoporosis/osteopenia; t-test p = 0.30).

Conclusion: Our results indicate that adherence to IDSA BMD screening guidelines in VLWH can be improved. Given that nearly half of the screened patients showed evidence of BMD loss on their initial DXA, efforts should be made to increase awareness and screening in this vulnerable population. Prevention, earlier diagnosis, and treatment of BMD loss in VLWH would likely lead to decreased morbidity associated with fractures due to low BMD in this population.