Osteoprotegerin and bone turnover markers in heavily pretreated HIV-infected patients

E. Seminari, A. Castagna, A. Soldarini, L. Galli, G. Fusetti, F. Dorigatti, H. Hasson, A. Danise, M. Guffanti, A. Lazzarin, A. Rubinacci

Research output: Contribution to journalArticlepeer-review


Objectives: To characterize osteoprotegerin (OPG) levels, bone remodelling and bone mineral density (BMD) in heavily pretreated HIV-infected patients on antiretroviral therapy, and to evaluate the clinical factors associated with bone density decline. Methods: Heavily pretreated (> 5 years) HIV-positive patients were enrolled in this cross-sectional, observational study, which was based on a total body bone densitometry examination and a comprehensive evaluation of bone and mineral parameters. Results: Sixty-eight patients (55 male and 13 female) with a median age of 41 years (range 25-60 years) were included in the study. Their antiretroviral treatment lasted for 82 months. On the basis of the World Health Organization criteria, nine patients (13.2%) were osteoporotic [T-score <- 2.5 standard deviation (SD)] and 19 patients (27.9%) were osteopenic (T-score between - 1 and - 2.5). The principal outcomes associated with the presence of a low BMD were high OPG and lysylpyridinoline/creatinine ratio (Dpd) values. Most of the patients (39 of 48; 81.25%) showed vitamin D insufficiency [Vitamin D (25(OH)D) <18 ng/mL] with secondary hyperparathyroidism (13 of 50 patients: 26%), which proved to be correlated to osteocalcin (BGP) levels [parathyroid hormone (PTH) vs. BGP: r = 0.34; P <0.01]. There was an inverse correlation between T-scores and serum osteocalcin and alkaline phosphatase (AP) levels, on one hand, and Dpd, on the other. High AP and Dpd values were associated with relative risks of 4.1 [95% confidence interval (CI) = 1.01-17.6] and 7.2 (95% CI = 1.67-31.03), respectively, of a pathological T-score. Multivariate analysis revealed that the factors associated with the presence of osteopenia or osteoporosis were older age and lower body mass index. Conclusions: About 40% of our heavily pretreated subjects with advanced HIV infection had a low BMD, and 56% (24 of 44 patients) showed a high bone turnover rate with marked osteoclast activation. High OPG levels may protect against bone resorption.

Original languageEnglish
Pages (from-to)145-150
Number of pages6
JournalHIV Medicine
Issue number3
Publication statusPublished - May 2005


  • Antiretroviral therapy
  • HIV infection
  • Osteopenia
  • Osteoprotegerin

ASJC Scopus subject areas

  • Immunology
  • Virology
  • Medicine(all)


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