The Impact of Human Immunodeficiency Virus and Menopause on Bone Mineral Density: A Longitudinal Study of Urban-Dwelling South African Women

An estimated 25% of South African women live with human immunodeficiency virus (HIV). Antiretroviral therapy roll-out has improved life expectancy, so many more women now reach menopause. We aimed to quantify changes in bone mineral density (BMD) during the menopausal transition in urban-dwelling South African women with and without HIV and determine whether HIV infection modified the effect of menopause on BMD changes. A 5-year population-based longitudinal study recruited women aged 40-60 years residing in Soweto and collected demographic and clinical data, including HIV status, anthropometry, and BMD, at baseline and at 5-year follow-up. All women were staged as pre-, peri-, or postmenopausal at both time points. Multivariable linear regression assessed relationships and interactions between HIV infection, menopause, and change in BMD. At baseline, 450 women had mean age 49.5 (SD 5.7) years, 65 (14.4%) had HIV, and 140 (31.1%), 119 (26.4%), and 191 (42.4%) were pre-, peri-, and postmenopausal, respectively; 34/205 (13.6%) women >= 50 years had a total hip (TH) or lumbar spine (LS) T-score <= similar to 2.5. At follow-up 38 (8.4%), 84 (18.7%), and 328 (72.9%) were pre-, peri-, and postmenopausal. Those with HIV at baseline lostmore total body (TB) BMD (mean difference similar to 0.013 [95% confidence interval similar to 0.026, similar to 0.001] g/cm(2), p = 0.040) and gained more weight 1.96 [0.32, 3.60] kg; p = 0.019 than HIV-uninfected women. After adjusting for age, baseline weight, weight change, and follow-up time, the transition from pre- to postmenopause was associated with greater TB BMD losses in women with HIV (similar to 0.092 [similar to 0.042, similar to 0.142] g/cm(2); p= 0.001) than without HIV (similar to 0.038 [similar to 0.016, similar to 0.060] g/cm(2), p = 0.001; interaction p = 0.034). Similarly, in womenwho were postmenopausal at both time points, those with HIV lost more TB BMD (similar to 0.070 [similar to 0.031, similar to 0.108], p = 0.001) than women without HIV (similar to 0.036 [similar to 0.015, similar to 0.057], p= 0.001, interaction p= 0.049). Findings were consistent but weaker at the LS and TH. Menopause-related bone loss is greater in women with HIV, suggesting women with HIV may be at greater risk of osteoporotic fractures. HIV services should consider routine bone health assessment in midlife women as part of long-term HIV care delivery. (c) 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Automated summary

This study aimed to investigate the changes in bone mineral density (BMD) during the menopausal transition in South African women with and without HIV, and found that HIV infection exacerbated the effect of menopause on BMD, indicating that women with HIV are at increased risk of osteoporosis.