The Use of Calcaneal Quantitative Ultrasound as a Bone Health Screening Tool Amongst People Living with HIV and Taking Tenofovir-Based Antiretroviral Therapy: A Pilot Study.

Background/Objectives: Individuals living with human immunodeficiency virus (HIV) receiving tenofovir-based antiretroviral therapy (ART) are at increased risk of bone loss. Dual-energy X-ray absorptiometry (DXA), the gold standard for determining bone mineral density (BMD), has limited accessibility. Calcaneal quantitative ultrasound (QUS) is an alternative screening tool for bone health, but its performance needs validation. The study aims to compare the performance of QUS between men with HIV on tenofovir-based ART and uninfected men. Methods: A cross-sectional study involving 52 men with HIV on tenofovir-based ART and 42 uninfected men was performed. Their bone health status was determined using DXA (lumbar spine and femoral neck) and QUS (calcaneus). The performance of QUS in identifying individuals with low BMD (DXA T-score < -1) was evaluated using receiver-operating characteristic curve analysis. Results: The HIV-ART group showed significantly lower QUS indices compared to the non-HIV-ART group (p < 0.05). The performance of QUS in identifying individuals with low BMD was poor in the HIV-ART group (p > 0.05), but moderate in the non-HIV-ART group (p < 0.05). After optimising the cutoffs, the performance of QUS was improved in the non-HIV-ART group but not in the HIV-ART group. Conclusions: QUS was not effective in identifying individuals with low BMD in men with HIV on ART. Its utility as a standalone screening tool in this population may be limited. Additional or more sensitive methods should be prioritised for bone health screening.