Most Older Adults With HIV Miss Bone Density Scans

Nearly 90% of people older than 50 years living with HIV have not undergone bone mineral density testing, based on data from approximately 12,000 individuals.

Factors including chronic inflammation, immune dysfunction, and side effects from antiretroviral therapy may contribute to accelerated aging in people with HIV, wrote Veronica J. Brady, PhD, of the University of Texas, Houston, and colleagues in a study presented at the study presented at the annual meeting of the Association of Nurses in AIDS Care. 

Additionally, “People with HIV (PWH) are living longer, therefore their risk of adverse health conditions associated with aging is increasing, Brady said in an interview. 

Previous research has shown associations between aging with HIV and bone loss and increased risk of osteoporosis, the researchers noted. 

Current guidelines recommend bone mineral density (BMD) testing for all men with PWH older than 50 years, all postmenopausal women, adults with fragility fractures regardless of age, but data on healthcare compliance with the recommendations are limited, Brady said. “It is important to evaluate how compliant we as healthcare providers are being/have been with recommendations over the years, as this information will give us guidance on how to focus our efforts,” she told Medscape Medical News. 

In a case-control study, the researchers reviewed data from 12,112 PWH using the EPIC database for individuals treated at a safety net institution between 2008 and 2023. 

Approximately half of these patients (48%) were aged > 50 years, and 89% of this subgroup (5166 individuals) had not had dual-energy x-ray absorptiometry (DXA) scanning. 

“It was disappointing and surprising to see how few PWH over the age of 50 years were having BMD testing done,” Brady told Medscape Medical News. The ethnicity of PWH without DXA broke down as 758 Hispanic, 3956 non-Hispanic (including Black, White, Asian, and multiracial) individuals, and 452 unknown. A majority of the patients who were tested were non-Hispanic (443 of 647). 

The most common venues for DXA scanning in PWH were breast imaging mammography (21.41%) and radiology (17.41%). 

“It is imperative that we provide the highest level of care in compliance with recommendations in order to address/mitigate preventable complications/side effects of treatment,” Brady told Medscape. Looking ahead, more research is needed to identify risk factors for changes in BMD and decreased bone strength in PWH and that ages at which these changes first appear, she said. 

Action is Needed to Increase Screening Rates

People with HIV are at greater risk for decreased bone mineral density and therefore other adverse health outcomes, including fractures, said Rachel K. Wion, PhD, RN, assistant professor at Indiana University School of Nursing, Indianapolis, in an interview. “Health inequities also contribute to a higher risk of these negative impacts,” said Wion, who was not involved in the current study. 

Current guidelines recommend BMD screening using DXA at age ≥ 50 years for PWH, which is much younger than the general population [age ≥ 75 years for men and > 65 years for postmenopausal women], said Wion. Early detection of decreased BMD in people with HIV is essential for early intervention to prevent further bone loss, she said. 

In the current study, “using several years of retrospective data from a safety net institution is important in determining whether those who are most at risk for premature bone loss are meeting the recommended guidelines for screening,” Wion noted.

“I was surprised that only 11% of PWH over the age of 50 met the recommended guidelines for BMD screening,” Wion told Medscape Medical News. “I expected the adherence to the screening guidelines to be low based on previous research. However, 11% was much lower than I anticipated.”

The study findings emphasize the need to improve adherence to the recommended guidelines for BMD screening in people with HIV, said Wion. 

“The next step in this line of research would be to determine why providers aren’t meeting the recommended guidelines [for BMD screening in PWH],” she said. “A study that focuses on barriers and facilitators to screening for both providers and patients is essential,” she added. Intervention studies aimed at increasing uptake of BMD screening in PWH > 50 years are also needed, Wion said.

The study received no outside funding. Brady had no financial conflicts to disclose, but is president-elect of the ADCES. Wion had no financial conflicts to disclose.