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Assessment of radiological vertebral fractures in HIV ‐infected patients: clinical implications and predictive factors
Author(s) -
Gazzola L,
Savoldi A,
Bai F,
Magenta A,
Dziubak M,
Pietrogrande L,
Tagliabue L,
Del Sole A,
Bini T,
Marchetti G,
d'Arminio Monforte A
Publication year - 2015
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12267
Subject(s) - medicine , odds ratio , confidence interval , deformity , asymptomatic , bone mineral , univariate analysis , rachis , lumbar , vertebra , osteoporosis , surgery , multivariate analysis
Objectives The aim of this study was to evaluate the clinical impact of including lateral spine X ‐ray in the screening of bone diseases in HIV ‐positive patients. Methods A total of 194 HIV ‐positive patients underwent dual‐energy X ‐ray absorptiometry ( DEXA ), lateral spine X ‐ray and bone biochemical analysis. Vertebral fractures were identified using a morphometric analysis of X ‐rays and classified using the semiquantitative scoring system of G enant et al . For each patient, a spine deformity index ( SDI ) score was calculated by summing the grades of vertebral deformities. Reductions in vertebral body height of > 25% were considered vertebral fractures, and those < 25% were considered vertebral deformities. Risk factors associated with vertebral fractures were evaluated by univariate and multivariate analysis. Results Vertebral fractures were detected in 24 patients (12.4%) and vertebral deformities in 17 patients (8.7%); 153 patients (78.9%) did not show any vertebral deformity. Among patients with fractures, only two with SDI > 10 reported lumbar pain; the remaining were asymptomatic. Patients over 50 years old showed a higher prevalence of vertebral fracture [24.4% versus 11.8% in patients 41–50 years old ( P = 0.05) and 1.9% in patients ≤ 40 years old ( P = 0.04)]. No significant increase in the prevalence according to bone mineral density ( BMD ) reduction was observed, and 70% of fractures were diagnosed in nonosteoporotic patients. Older age [adjusted odds ratio 1.09; 95% confidence interval ( CI ) 1.03–1.13; P = 0.001] and steroid use (adjusted odds ratio 3.64; 95% CI 1.29–10.3; P = 0.01) were independently associated with vertebral fracture; no association was found with HIV ‐ or highly active antiretroviral therapy ( HAART )‐related variables. Conclusions A prevalence of vertebral fractures of 12.4% was observed in our HIV ‐positive cohort. Given that two‐thirds of fractures occurred in nonosteoporotic patients, spine X ‐ray may be considered in patients at increased risk, irrespective of BMD ; that is, in elderly patients and/or patients using steroids.