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Prolonged Amenorrhea and Low Hip Bone Mineral Density in Women Living with HIV-a Controlled, Cross-Sectional Study

King EM1Nesbitt A1Albert AYK2,3Pick N1,2,3Cote HCF2,4Maan EJ2,3Prior JC2,5Murray MCM1,2,3CIHR team on Cellular Aging and HIV Comorbidities in Women and Children (CARMA).

J Acquir Immune Defic Syndr. 2020 Jan 6. doi: 10.1097/QAI.0000000000002282. [Epub ahead of print]





Women living with HIV (WLWH) have higher rates of prolonged secondary amenorrhea (no flow for ≥1-year) than HIV-negative women. Both having amenorrhea and being HIV+ are associated with lower areal bone mineral density (BMD). However, their combined BMD effects remain unclear. Therefore, we investigated prolonged amenorrhea and BMD in WLWH and controls.


This cross-sectional study enrolled WLWH and HIV-negative control women aged 19-68 of similar sociocultural backgrounds. We assessed BMD (Hologic, as age-, ethnicity-matched Z-Scores) in the CARMA cohort. Participants were stratified by amenorrhea history defined as past/present lack of menses for ≥1-year at age <45-not due to surgery, breastfeeding, pregnancy or hormonal contraception. Hip and spine Z-Scores by amenorrhea/no amenorrhea used linear models with multivariable analysis for relationships within WLWH.


WLWH (N=129) were similar to controls (N=129) in age, BMI, ethnicity and substance use. Amongst WLWH, 21% experienced prolonged amenorrhea vs. 9% in controls. WLWH had significantly lower total hip (mean ± SD -0.4±0.9 vs. 0.3±1.1; p<0.001) and spine (-0.5±1.3 vs. 0.2±1.3; p=0.001) Z-Scores than controls. Amenorrhea was independently associated with hip (p=0.01), but not spine (p=0.94) BMD by multivariable linear regression. WLWH with amenorrhea had lower hip Z-scores (-0.8±0.9) than those without (-0.3±0.8; p=0.01). They also had higher rates of substance use, smoking, opioid therapy, hepatitis C co-infection, and lower CD4 nadirs.


WLWH had higher rates of prolonged amenorrhea and lower BMD than controls. WLWH with amenorrhea experienced lower hip BMD Z-Scores than those without. Prolonged amenorrhea is an added osteoporosis risk in WLWH.