Comparison of Receptor Activator of Nuclear Factor Kappa-B Ligand and Osteoprotegerin with Other Serum Biomarkers for Bone Homeostasis in People Living with HIV
Pınar Belviranlı Keskin, İbrahim Erayman, Bahar Kandemir, Rukiyye BulutIntroduction:
This study evaluated Bone Mineral Density (BMD) and examined the associations of serum Receptor Activator of Nuclear factor kappa-B Ligand (RANKL), Osteo-protegerin (OPG), and the RANKL/OPG ratio with Dual-energy X-ray Absorptiometry (DXA) findings and clinical parameters in people living with HIV (PLWH) receiving Antiretroviral Ther-apy (ART).
Methods:
In this prospective cross-sectional study, adults living with HIV were consecutively recruited at a tertiary care center. Participants underwent DXA, measurement of serum RANKL and OPG levels, and routine biochemical and hematological testing. Clinical and laboratory var-iables were compared according to BMD status, and multivariable linear regression analyses were performed to identify factors associated with RANKL, OPG, and the RANKL/OPG ratio.
Results:
Low BMD was identified in 20 participants (25.0%), including 14 (17.5%) at the femoral neck and 12 (15.0%) at the lumbar spine. Participants with low BMD were older than those with normal BMD (median 54.0 vs 35.0 years, p = 0.017). Serum RANKL, OPG, and the RANKL/OPG ratio did not differ significantly according to BMD status. In multivariable models, hemoglobin and age were independently and inversely associated with the RANKL/OPG ratio (p = 0.028 and p = 0.041, respectively), whereas age and neutrophil percentage were independently and inversely associated with serum RANKL (p = 0.001 and p = 0.048, respectively) and OPG levels (p = 0.002 and p = 0.023, respectively).
Discussion:
These findings suggest that circulating RANKL and OPG may not adequately reflect DXA-derived skeletal status in ART-treated PLWH and may be influenced by broader systemic, inflammatory, and hematologic factors.
Conclusion:
Direct densitometric assessment remains central to skeletal evaluation in PLWH re-ceiving ART.