Height adjustment reduces occurrence of low bone mineral density in children and adolescents with HIV

Andrade, Leonardo Bandeira de; Nogueira, Thiago Fachini; Vargas, Deisi Maria

doi:10.1590/1806-9282.20210137

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Original Article • Rev. Assoc. Med. Bras. 67 (9) • Sept 2021 • https://doi.org/10.1590/1806-9282.20210137 copy

Height adjustment reduces occurrence of low bone mineral density in children and adolescents with HIV

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

The aim of this study was to quantify the reduction of bone mineral density with and without height adjustment.

METHODS:

A cross-sectional study was performed with 69 Brazilian children and adolescents vertically infected by HIV. Bone mineral density was measured by dual-energy absorptiometry in the lumbar spine. Anthropometric, demographic, and clinical variables were analyzed. A specific calculator was used for height adjustment.

RESULTS:

The majority of participants (52.2%) were adolescents and did not present with immunological alterations (61%). Reduced bone mineral density (Z-score <-1) was present in 23.2% and low bone mass (Z-score <-2) in 5.8%. After height adjustment, these occurrences decreased to 11.6% and 0%, respectively. Patients with reduced bone mineral density had a higher mean age and lower body mass index than patients with normal bone mineral density.

CONCLUSION:

The occurrence of reduced bone mineral density decreased after adjustment for height.

KEYWORDS:
Bone mineral density; HIV; Child; Adolescent; Osteoporosis

Numerical Variables		Mean±SD	95%CI	Minimum	Maximum
Age (years)		1.5±3.6	9.6 to 11.3	5.0	18.5
Use of ATV (months)		41.1±31.3	33.2 to 49.1	0.0	197.0
CD4 (cells/mm³3 Jiménez B, Sainz T, Díaz L, Mellado MJ, Navarro ML, Rojo P, et al. Low bone mineral density in vertically HIV-infected children and adolescents: risk factors and the role of t-cell activation and senescence. Pediatr Infect Dis J. 2017;36:(6)578-83. https://doi.org/10.1097/INF.0000000000001506. https://doi.org/10.1097/INF.000000000000... )		757.8±429.0	654.8 to 860.9	47.0	2,177.0
BMI (Z-score)		−0.4±1.1	−0.7 to -0.2	−4.4	1.6
Weight (Z-score)		−0.8±1.1	−1.1 to -0.6	−3.3	1.6
Height (Z-score)		−0.9±0.9	−1.1 to -0.7	−2.9	1.1
BMD (g)		0.6±0.2	0.6 to 0.7	0.1	1.2
BMD (Z-score)		−0.3±1.3	−0.6 to 0.0	−4.1	3.2
Height adjusted BMD (Z-score)		0.3±1.1	0.1 to 0.6	−1.8	3.5
CD8 (cells/mm³3 Jiménez B, Sainz T, Díaz L, Mellado MJ, Navarro ML, Rojo P, et al. Low bone mineral density in vertically HIV-infected children and adolescents: risk factors and the role of t-cell activation and senescence. Pediatr Infect Dis J. 2017;36:(6)578-83. https://doi.org/10.1097/INF.0000000000001506. https://doi.org/10.1097/INF.000000000000... )		1,346.7±667.3	1,181.3 to 1,521.0	317.0	3,642.0
Viral load (copies/mL)		35,196.2±74,883.0	16,179.4 to 52,212.9	0	39,000.0
Categorical Variables		Frequency (n)		Relative Frequency (%)
Sex
	Male	33		47.8
	Female	36		52.2
Age
	Adolescent age	36		52.2
	School age	33		47.8
Immunologic category
	None or mild suppression	42		60.8
	Moderate suppression	23		33.4
	Severe suppression	4		5.8
Reduced BMD (Z-score <-1)
	Yes	16		23.2
	No	53		76.8
Low BMD (Z-score <-2)
	Yes	4		5.6
	No	65		94.4
Clinical categoryᵃ
	N	4		6.2
	A	19		29.2
	B	34		52.3
	C	8		12.3
Use of ATV
	Yes	68		98.6
	No	1		1.4
Use of protease inhibitors
	Yes	46		70.8
	No	19		29.2

Variables	Reduced aBMD (n=16)	Normal aBMD (n=53)		Reduced aBMD_HAZ (n=8)	Normal aBMD_HAZ (n=61)
Variables	Mean±SD/ n (%)	Mean±SD/ n (%)	p-value	Mean±SD/ n (%)	Mean±SD/ n (%)	p-value
Age (years)	13.5±2.9	9.5±3.5	<0.001^a a Student's t-test (power of test >75% for age, body mass index, and height, and <75% for the use of antiviral therapy, cells CD4, and cells CD8)	13.4±3.7	10.1±3.6	<0.001^a a Student's t-test (power of test >75% for age, body mass index, and height, and <75% for the use of antiviral therapy, cells CD4, and cells CD8)
Use of ATV (months)	51.6±28.5	37.8±31.6	NS^a a Student's t-test (power of test >75% for age, body mass index, and height, and <75% for the use of antiviral therapy, cells CD4, and cells CD8)	32.5±19.9	42.5±32.5	NS^a a Student's t-test (power of test >75% for age, body mass index, and height, and <75% for the use of antiviral therapy, cells CD4, and cells CD8)
CD4 (cells/mm³3 Jiménez B, Sainz T, Díaz L, Mellado MJ, Navarro ML, Rojo P, et al. Low bone mineral density in vertically HIV-infected children and adolescents: risk factors and the role of t-cell activation and senescence. Pediatr Infect Dis J. 2017;36:(6)578-83. https://doi.org/10.1097/INF.0000000000001506. https://doi.org/10.1097/INF.000000000000... )	616.8±575.8	800.3±370.2	NS^a a Student's t-test (power of test >75% for age, body mass index, and height, and <75% for the use of antiviral therapy, cells CD4, and cells CD8)	569.1±514.8	779.9±416.4	NS^a a Student's t-test (power of test >75% for age, body mass index, and height, and <75% for the use of antiviral therapy, cells CD4, and cells CD8)
CD8 (cells/mm³3 Jiménez B, Sainz T, Díaz L, Mellado MJ, Navarro ML, Rojo P, et al. Low bone mineral density in vertically HIV-infected children and adolescents: risk factors and the role of t-cell activation and senescence. Pediatr Infect Dis J. 2017;36:(6)578-83. https://doi.org/10.1097/INF.0000000000001506. https://doi.org/10.1097/INF.000000000000... )	1,252.7±614.4	1,374.8±685.7	NS^a a Student's t-test (power of test >75% for age, body mass index, and height, and <75% for the use of antiviral therapy, cells CD4, and cells CD8)	1,247.0±802.6	1,360.6±653.2	NS^a a Student's t-test (power of test >75% for age, body mass index, and height, and <75% for the use of antiviral therapy, cells CD4, and cells CD8)
BMI (Z-score)	−1.0±1.5	0.3±0.9	<0.05^a a Student's t-test (power of test >75% for age, body mass index, and height, and <75% for the use of antiviral therapy, cells CD4, and cells CD8)	−1.0±1.6	−0.4±-1.0	<0.05^a a Student's t-test (power of test >75% for age, body mass index, and height, and <75% for the use of antiviral therapy, cells CD4, and cells CD8)
Height (Z-score)	−0.8±0.9	−1.3±0.8	NS^a a Student's t-test (power of test >75% for age, body mass index, and height, and <75% for the use of antiviral therapy, cells CD4, and cells CD8)	−1.1±0.9	−0.9±0.9	NS^a a Student's t-test (power of test >75% for age, body mass index, and height, and <75% for the use of antiviral therapy, cells CD4, and cells CD8)
Use of protease inhibitor	9 (19.6)	37(80.4)	NS^b b Chi-square test.	4 (8.7)	42 (91.3)	NS^b b Chi-square test.

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[1] *Corresponding author: deisifurb@gmail.com