Baixa massa óssea em mulheres na menopausa vivendo com HIV
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Sep 1, 2023
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Resumo
Objetivo: Analisar aspectos clínicos e epidemiológicos da baixa massa óssea em mulheres na menopausa com HIV. Revisão bibliográfica: O maior acesso à terapia antirretroviral (TARV) resultou na melhora de sobrevida das pessoas vivendo com HIV, o que possibilitou envelhecimento dessa população. Muitas mulheres estão atingindo a fase de climatério/menopausa, cuja maior complexidade de manejo, constitui um grande desafio para o clínico. Em mulheres vivendo com HIV (MVH), além de fatores de risco tradicionais e específicos dessa infecção viral, soma-se o hipoestrogenismo, decorrente da falência ovariana, resultando em menor massa óssea e potencial risco de fraturas. Evidências sugerem que o rastreio periódico para baixa massa óssea, a suplementação de cálcio e vitamina D e tratamento da osteoporose com bisfosfonatos. Não há estudos robustos sobre o efeito da terapia hormonal da menopausa sobre o osso em MVH. Realizou-se a análise e revisão dos principais artigos disponíveis sobre massa óssea em mulheres vivendo com HIV (MVH) na pós-menopausa, discorrendo sobre fatores de risco associados, diagnóstico e tratamento. Considerações finais: É importante que clínicos estejam cientes de que MVH na pós-menopausa constituem um grupo de risco para baixa massa óssea, necessitando um manejo diferenciado, que vai muito além do controle da infecção viral.
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Como Citar
SilvaP. R. L. da, SilvaM. R. H. da S. e, Barbosa-FerreiraJ. M. B., & BenzakemA. S. (2023). Baixa massa óssea em mulheres na menopausa vivendo com HIV. Revista Eletrônica Acervo Saúde, 23(8), e13018. https://doi.org/10.25248/reas.e13018.2023
Seção
Revisão Bibliográfica
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Referências
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2. ALZAHRANI J, et al. Inflammatory and immunometabolic consequences of gut dysfunction in HIV: parallels with IBD and implications for reservoir persistence and non-AIDS comorbidities. EBioMedicine, 2019; 46:522–31.
3. BIVER E, et al. Diagnosis, prevention, and treatment of bone fragility in people living with HIV: a position statement from the Swiss Association against Osteoporosis. Osteoporos Int., 2019; 30(5): 1125–1135.
4. BLACK DM, et al. The effect of 6 versus 9 years of zoledronic acid treatment in osteoporosis: a randomized second extension to the HORIZON-Pivotal Fracture Trial (PFT). J Bone Miner Res., 2015; 30: 934-944.
5. BOLLAND MJ, et al. Effects of intravenous zoledronate on bone turnover and bone density persist for at least five years in HIV-infected men. J Clin Endocrinol Metab., 2012; 97(6): 1922–1928.
6. BONE HG et al; Alendronate Phase III Osteoporosis Treatment Study Group. Ten years experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med., 2004; 350: 1189-1199.
7. BRASIL. Ministério da Saúde. Banco de dados do Sistema Único de Saúde-DATASUS. Disponível em http://www.datasus.gov.br. Acessado em 30 de janeiro de 2023.
8. BROWN TT, et al. Loss of bone mineral density after antiretroviral therapy initiation, independent of antiretroviral regimen. J Acquir Immune Defic Syndr., 2009; 51: 554–61.
9. CAULEY JA, et al. Women’s Health Initiative Investigators. Effects of estrogen plus progestin on risk of fracture and bone mineral density: The Women’s Health Initiative randomized trial. JAMA, 2003; 290: 1729-1738.
10. CHANG CJ, et al. People with HIV infection had lower bone mineral density and increased fracture risk: a meta-analysis. Arch Osteoporos, 2021; 16(1): 47.
11. COMPSTON JE, et al. Osteoporosis. Lancet, 2019; 26(393): 364-376.
12. CORTÉS YI, et al. Bone Density and Fractures in HIV-infected Postmenopausal Women: A Systematic Review. J Assoc Nurses AIDS Care, 2015; 26(4): 387-98.
13. COTTER AG e POWDERLY WG. Endocrine complications of human immunodeficiency virus infection: hypogonadism, bone disease and tenofovir-related toxicity. Best Res Clin End Metab., 2011; 25: 501–15.
14. DELPINO MV e QUARLERI J. Influence of HIV infection and antiretroviral therapy on bone homeostasis. Front Endocrinol., 2020; 11:502.
15. FARR JN e KHOSLA S. Skeletal changes through the lifespan—from growth to senescence. Nat Rev Endocrinol., 2015; 11: 513-521.
16. FINK HA, et al. Long-term drug therapy and drug discontinuations and holidays for osteoporosis fracture prevention: a systematic review. Ann Intern Med., 2019; 171: 37-50.
17. GIBELLINI D, et al. Analysis of the effects of specific protease inhibitors on OPG/RANKL regulation in an osteoblast-like cell line. New Microbiol., 2010; 33: 109–15.
18. GREENDALE GA, et al. Bone mineral density loss in relation to the final menstrual period in a multiethnic cohort: Results from the Study of Women’s Health Across the Nation (SWAN). J Bone Miner Re., 2012; 27(1): 111–118.
19. GUARALDI G, et al. Aging with HIV vs. HIV seroconversion at older age: a diverse population with distinct comorbidity profiles. PLoS ONE, 2015; 10: e0118531.
20. HANSEN D, et al. Medicare Cost of Osteoporotic Fractures: 2021 Updated Report: The Clinical and Cost Burden of Fractures Associated with Osteoporosis. National Osteoporosis Foundation, 2021.
21. HASKELBERG H, et al. Changes in bone turnover and bone loss in HIV-infected patients changing treatment to tenofovir-emtricitabine or abacavir-lamivudine. PLoS ONE, 2012; 7: e38377.
22. HOSKING D, et al. Prevention of bone loss with alendronate in postmenopausal women under 60 years of age. Early Postmenopausal Intervention Cohort Study Group. N Engl J Med., 1998; 338: 485-492.
23. HOWELLS P, et al. Experience of hormone replacement therapy in postmenopausal women living with HIV. Post Reprod Health., 2019; 25(2): 80-85.
24. IN DANGER: UNAIDS Global AIDS Update 2022. Joint United Nations Programme on HIV/AIDS; 2022.
25. KANIS JA et al. The diagnosis of osteoporosis. J Bone Miner Res., 1994; 9(8): 1137–114.
26. LeBOFF M, et al. The clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int., 2022; 33: 2049–2102.
27. LEWDEN C e BOUTELOUP V. All-cause mortality in treated HIV-infected adults with CD4 > 500/mm3 compared with the general population: Evidence from a large European observational cohort collaboration. Int J Epidemiol., 2012; 41: 433–445.
28. LOOKER AC, et al. Trends in osteoporosis and low bone mass in older US adults, 2005-2006 through 2013-2014. Osteoporos Int., 2017; 28: 1979 -1988.
29. LORENTZON M e CUMMINGS SR. Osteoporosis: the evolution of a diagnosis. J Intern Med., 2015; 277: 650–61.
30. MAZZITELLI M, et al. FRAX assessment in people ageing with HIV. HIV Med., 2022; 23(1): 103-108.
31. McCLUNG M, et al. Bisphosphonate therapy for osteoporosis: benefits, risks, and drug holiday. Am J Med., 2013; 126: 13-20.
32. McCOMSEY GA, et al. Bone disease in HIV infection: a practical review and recommendations for HIV care providers. Clin Infect Dis., 2010; 51(8): 937-46.
33. McCOMSEY GA et al. Bone mineral density and fractures in antiretroviral-naive persons randomized to receive abacavir-lamivudine or tenofovir disoproxil fumarate-emtricitabine along with efavirenz or atazanavir-ritonavir: aids clinical trials group A5224s, a substudy of ACTG A5202. J Infect Dis., 2011; 203: 1791–801.
34. NAMS. Management of Osteoporosis in Postmenopausal Women: The 2021 Position Statement of The North American Menopause Society’’ Editorial Panel. Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society. Menopause, 2021; 28(9): 973-997.
35. NEGREDO E, et al. Comparison of two different strategies of treatment with zoledronate in HIV-infected patients with low bone mineral density: single dose versus two doses in 2 years. HIV Med., 2015; 16(7): 441–448.
36. NIH. Consensus development panel on osteoporosis prevention, diagnosis and therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA, 2001; 285(6): 785-95.
37. OFOTOKUN I, et al. Antiretroviral therapy induces a rapid increase in bone resorption that is positively associated with the magnitude of immune reconstitution in HIV infection. AIDS, 2016; 30: 405–14.
38. OVERTON ET, et al. Vitamin D and calcium attenuate bone loss with antiretroviral therapy initiation: a randomized trial. Ann Intern Med., 2015; 162(12): 815–824.
39. PAPADAKIS G, et al. The benefit of menopausal hormone therapy on bone density and microarchitecture persists after its withdrawal. J Clin Endocrinol Metab., 2016; 101: 5004- 5011.
40. PETERS BS, et al. Prevalence of vitamin D insufciency in Brazilian adolescents. Ann Nutr Metab., 2009; 54: 15–21.
41. PRAMUKTI I, et al. Bone fracture among people living with HIV: a systematic review and meta-regression of prevalence, incidence, and risk factors. PLoS ONE, 2020; 15(6): e0233501.
42. PRIOR J, et al. Fragility fractures and bone mineral density in HIV positive women: a case-control population-based study. Osteoporos Int., 2007; 18(10): 1345-53.
43. SALARI N, et al. The global prevalence of osteoporosis in the world: a comprehensive systematic review and meta-analysis. J Orthop Surg Res., 2021; 16(1): 609.
44. SALARI N, et al. Global prevalence of osteoporosis among the world older adults: a comprehensive systematic review and meta-analysis. J Orthop Surg Res., 2021; 16(1): 669.
45. SCHUIT SC, et al. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone, 2004; 34: 195–202.
46. SHIAU S, et al. Bone Update: Is It Still an Issue Without Tenofovir Disoproxil Fumarate? Curr HIV/AIDS Rep., 2020; 17(1): 1-5.
47. STARUP-LINDE J, et al. Management of osteoporosis in patients living with HIV-A systematic review and meta-analysis. J Acquir Immune Defc Syndr., 2020; 83(1): 1–8.
48. VANCE DE, et al. Successful aging and the epidemiology of HIV. Clin Interv Aging, 2011; 6: 181–192.
49. WANG H, et al. The efficacy and safety of tenofovir alafenamide versus tenofovir disoproxil fumarate in antiretroviral regimens for HIV-1 therapy: metaanalysis. Medicine, 2016; 95: e5146.
50. YIN MT e FALUTZ J. How to predict the risk of fracture in HIV? Curr Opin HIV AIDS, 2016; 11(3): 261-7.
51. YIN MT, et al. Hormone therapy and fractures in postmenopausal women. AIDS, 2022; 36(12): 1683-1688.
52. YIN MT, et al. A Randomized Placebo-Controlled Trial of Low- Versus Moderate-Dose Vitamin D3 Supplementation on Bone Mineral Density in Postmenopausal Women With HIV. J Acquir Immune Defic Syndr., 2019; 80(3): 342-349.
2. ALZAHRANI J, et al. Inflammatory and immunometabolic consequences of gut dysfunction in HIV: parallels with IBD and implications for reservoir persistence and non-AIDS comorbidities. EBioMedicine, 2019; 46:522–31.
3. BIVER E, et al. Diagnosis, prevention, and treatment of bone fragility in people living with HIV: a position statement from the Swiss Association against Osteoporosis. Osteoporos Int., 2019; 30(5): 1125–1135.
4. BLACK DM, et al. The effect of 6 versus 9 years of zoledronic acid treatment in osteoporosis: a randomized second extension to the HORIZON-Pivotal Fracture Trial (PFT). J Bone Miner Res., 2015; 30: 934-944.
5. BOLLAND MJ, et al. Effects of intravenous zoledronate on bone turnover and bone density persist for at least five years in HIV-infected men. J Clin Endocrinol Metab., 2012; 97(6): 1922–1928.
6. BONE HG et al; Alendronate Phase III Osteoporosis Treatment Study Group. Ten years experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med., 2004; 350: 1189-1199.
7. BRASIL. Ministério da Saúde. Banco de dados do Sistema Único de Saúde-DATASUS. Disponível em http://www.datasus.gov.br. Acessado em 30 de janeiro de 2023.
8. BROWN TT, et al. Loss of bone mineral density after antiretroviral therapy initiation, independent of antiretroviral regimen. J Acquir Immune Defic Syndr., 2009; 51: 554–61.
9. CAULEY JA, et al. Women’s Health Initiative Investigators. Effects of estrogen plus progestin on risk of fracture and bone mineral density: The Women’s Health Initiative randomized trial. JAMA, 2003; 290: 1729-1738.
10. CHANG CJ, et al. People with HIV infection had lower bone mineral density and increased fracture risk: a meta-analysis. Arch Osteoporos, 2021; 16(1): 47.
11. COMPSTON JE, et al. Osteoporosis. Lancet, 2019; 26(393): 364-376.
12. CORTÉS YI, et al. Bone Density and Fractures in HIV-infected Postmenopausal Women: A Systematic Review. J Assoc Nurses AIDS Care, 2015; 26(4): 387-98.
13. COTTER AG e POWDERLY WG. Endocrine complications of human immunodeficiency virus infection: hypogonadism, bone disease and tenofovir-related toxicity. Best Res Clin End Metab., 2011; 25: 501–15.
14. DELPINO MV e QUARLERI J. Influence of HIV infection and antiretroviral therapy on bone homeostasis. Front Endocrinol., 2020; 11:502.
15. FARR JN e KHOSLA S. Skeletal changes through the lifespan—from growth to senescence. Nat Rev Endocrinol., 2015; 11: 513-521.
16. FINK HA, et al. Long-term drug therapy and drug discontinuations and holidays for osteoporosis fracture prevention: a systematic review. Ann Intern Med., 2019; 171: 37-50.
17. GIBELLINI D, et al. Analysis of the effects of specific protease inhibitors on OPG/RANKL regulation in an osteoblast-like cell line. New Microbiol., 2010; 33: 109–15.
18. GREENDALE GA, et al. Bone mineral density loss in relation to the final menstrual period in a multiethnic cohort: Results from the Study of Women’s Health Across the Nation (SWAN). J Bone Miner Re., 2012; 27(1): 111–118.
19. GUARALDI G, et al. Aging with HIV vs. HIV seroconversion at older age: a diverse population with distinct comorbidity profiles. PLoS ONE, 2015; 10: e0118531.
20. HANSEN D, et al. Medicare Cost of Osteoporotic Fractures: 2021 Updated Report: The Clinical and Cost Burden of Fractures Associated with Osteoporosis. National Osteoporosis Foundation, 2021.
21. HASKELBERG H, et al. Changes in bone turnover and bone loss in HIV-infected patients changing treatment to tenofovir-emtricitabine or abacavir-lamivudine. PLoS ONE, 2012; 7: e38377.
22. HOSKING D, et al. Prevention of bone loss with alendronate in postmenopausal women under 60 years of age. Early Postmenopausal Intervention Cohort Study Group. N Engl J Med., 1998; 338: 485-492.
23. HOWELLS P, et al. Experience of hormone replacement therapy in postmenopausal women living with HIV. Post Reprod Health., 2019; 25(2): 80-85.
24. IN DANGER: UNAIDS Global AIDS Update 2022. Joint United Nations Programme on HIV/AIDS; 2022.
25. KANIS JA et al. The diagnosis of osteoporosis. J Bone Miner Res., 1994; 9(8): 1137–114.
26. LeBOFF M, et al. The clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int., 2022; 33: 2049–2102.
27. LEWDEN C e BOUTELOUP V. All-cause mortality in treated HIV-infected adults with CD4 > 500/mm3 compared with the general population: Evidence from a large European observational cohort collaboration. Int J Epidemiol., 2012; 41: 433–445.
28. LOOKER AC, et al. Trends in osteoporosis and low bone mass in older US adults, 2005-2006 through 2013-2014. Osteoporos Int., 2017; 28: 1979 -1988.
29. LORENTZON M e CUMMINGS SR. Osteoporosis: the evolution of a diagnosis. J Intern Med., 2015; 277: 650–61.
30. MAZZITELLI M, et al. FRAX assessment in people ageing with HIV. HIV Med., 2022; 23(1): 103-108.
31. McCLUNG M, et al. Bisphosphonate therapy for osteoporosis: benefits, risks, and drug holiday. Am J Med., 2013; 126: 13-20.
32. McCOMSEY GA, et al. Bone disease in HIV infection: a practical review and recommendations for HIV care providers. Clin Infect Dis., 2010; 51(8): 937-46.
33. McCOMSEY GA et al. Bone mineral density and fractures in antiretroviral-naive persons randomized to receive abacavir-lamivudine or tenofovir disoproxil fumarate-emtricitabine along with efavirenz or atazanavir-ritonavir: aids clinical trials group A5224s, a substudy of ACTG A5202. J Infect Dis., 2011; 203: 1791–801.
34. NAMS. Management of Osteoporosis in Postmenopausal Women: The 2021 Position Statement of The North American Menopause Society’’ Editorial Panel. Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society. Menopause, 2021; 28(9): 973-997.
35. NEGREDO E, et al. Comparison of two different strategies of treatment with zoledronate in HIV-infected patients with low bone mineral density: single dose versus two doses in 2 years. HIV Med., 2015; 16(7): 441–448.
36. NIH. Consensus development panel on osteoporosis prevention, diagnosis and therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA, 2001; 285(6): 785-95.
37. OFOTOKUN I, et al. Antiretroviral therapy induces a rapid increase in bone resorption that is positively associated with the magnitude of immune reconstitution in HIV infection. AIDS, 2016; 30: 405–14.
38. OVERTON ET, et al. Vitamin D and calcium attenuate bone loss with antiretroviral therapy initiation: a randomized trial. Ann Intern Med., 2015; 162(12): 815–824.
39. PAPADAKIS G, et al. The benefit of menopausal hormone therapy on bone density and microarchitecture persists after its withdrawal. J Clin Endocrinol Metab., 2016; 101: 5004- 5011.
40. PETERS BS, et al. Prevalence of vitamin D insufciency in Brazilian adolescents. Ann Nutr Metab., 2009; 54: 15–21.
41. PRAMUKTI I, et al. Bone fracture among people living with HIV: a systematic review and meta-regression of prevalence, incidence, and risk factors. PLoS ONE, 2020; 15(6): e0233501.
42. PRIOR J, et al. Fragility fractures and bone mineral density in HIV positive women: a case-control population-based study. Osteoporos Int., 2007; 18(10): 1345-53.
43. SALARI N, et al. The global prevalence of osteoporosis in the world: a comprehensive systematic review and meta-analysis. J Orthop Surg Res., 2021; 16(1): 609.
44. SALARI N, et al. Global prevalence of osteoporosis among the world older adults: a comprehensive systematic review and meta-analysis. J Orthop Surg Res., 2021; 16(1): 669.
45. SCHUIT SC, et al. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone, 2004; 34: 195–202.
46. SHIAU S, et al. Bone Update: Is It Still an Issue Without Tenofovir Disoproxil Fumarate? Curr HIV/AIDS Rep., 2020; 17(1): 1-5.
47. STARUP-LINDE J, et al. Management of osteoporosis in patients living with HIV-A systematic review and meta-analysis. J Acquir Immune Defc Syndr., 2020; 83(1): 1–8.
48. VANCE DE, et al. Successful aging and the epidemiology of HIV. Clin Interv Aging, 2011; 6: 181–192.
49. WANG H, et al. The efficacy and safety of tenofovir alafenamide versus tenofovir disoproxil fumarate in antiretroviral regimens for HIV-1 therapy: metaanalysis. Medicine, 2016; 95: e5146.
50. YIN MT e FALUTZ J. How to predict the risk of fracture in HIV? Curr Opin HIV AIDS, 2016; 11(3): 261-7.
51. YIN MT, et al. Hormone therapy and fractures in postmenopausal women. AIDS, 2022; 36(12): 1683-1688.
52. YIN MT, et al. A Randomized Placebo-Controlled Trial of Low- Versus Moderate-Dose Vitamin D3 Supplementation on Bone Mineral Density in Postmenopausal Women With HIV. J Acquir Immune Defic Syndr., 2019; 80(3): 342-349.