# Bone quality and marrow adiposity in subjects with HIV

> **NIH NIH R01** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2021 · $487,953

## Abstract

HIV-infected individuals experience up to 4-fold higher annual rates of fragility fractures than the general
population. As HIV-infected individuals live longer through effective antiretroviral therapy (ART), fracture
rates are expected to further increase in the future. While several studies have emphasized an increased
fracture incidence in HIV-infected patients, this increased fracture incidence is not explained by differences
in bone mineral density (BMD) between HIV-infected individuals and healthy controls. An emerging
explanation for this paradox is that HIV infection and treatment are associated with bone quality changes –
including changes in bone geometry and microstructure – that do not impact BMD but do increase fracture
risk. To date, only a few studies have investigated bone quality and only at the distal extremities. However,
the proximal femur is an important site for fragility fracture. Hence, a critical gap in knowledge is whether
bone quality at central skeletal sites, including the spine and hip, is similarly affected by HIV infection and
therapy. Thus, a critical barrier to progress in the field is a lack of understanding of bone quality changes in
HIV infected subjects. A potential mechanism influencing low bone quality in HIV could be an imbalance in
bone and fat cell differentiation. Thus, bone marrow fat (BMF) could potentially be another important
biomarker for bone health. A better understanding of these relationships could translate into new
approaches for fracture risk assessment, drug development, and therapy monitoring in HIV-infected
patients. We have identified three working hypotheses: (1) Significant micro-structural deterioration and
reduction in biomechanical competence will be detected in HIV-infected patients at both peripheral and
central sites and will reveal larger differences between HIV-infected and control groups than BMD data
from DXA alone; (2) Increased BMF will be detected in HIV-infected patients compared to healthy controls
and will be associated with increased visceral adiposity and decreased HIV-associated subcutaneous
adiposity; and (3) Increased BMF will partially explain the association of HIV with poor bone quality. These
hypotheses will be tested by pursuing the following Specific Aims: (1) Quantify differences in bone density,
structure, and mechanical properties between HIV-infected patients and uninfected controls; (2) Determine
differences in BMF between HIV-infected patients and uninfected controls; and (3) Determine the
relationship between BMF and bone quality in HIV-infected patients. The approach is innovative because it
combines novel in-vivo MRI and HR-pQCT imaging techniques to determine relationships between bone
features and BMF with voxel based morphormetry. The proposed research is significant because the
associations between bone quality and BMF have not yet been assessed in HIV-infected subjects. These
relationships may reveal pathobiological mechanisms at play in HIV, an...

## Key facts

- **NIH application ID:** 10067367
- **Project number:** 5R01AI125080-05
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** GALATEIA J KAZAKIA
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $487,953
- **Award type:** 5
- **Project period:** 2016-12-15 → 2023-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10067367

## Citation

> US National Institutes of Health, RePORTER application 10067367, Bone quality and marrow adiposity in subjects with HIV (5R01AI125080-05). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10067367. Licensed CC0.

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