Bone disease in HIV infection: a practical review and recommendations for HIV care providers.
Low bone mineral density (BMD) is prevalent in human immunodeficiency virus (HIV)-infected subjects. Initiation of antiretroviral therapy is associated with a 2%-6% decrease in BMD over the first 2 years, a decrease that is similar in magnitude to that sustained during the first 2 years of menopause. Recent studies have also described increased fracture rates in the HIV-infected population. The causes of low BMD in individuals with HIV infection appear to be multifactorial and likely represent a complex interaction between HIV infection, traditional osteoporosis risk factors, and antiretroviral-related factors. In this review, we make the point that HIV infection should be considered as a risk factor for bone disease. We recommend screening patients with fragility fractures, all HIV-infected post-menopausal women, and all HIV-infected men ⩾50 years of age. We also discuss the importance of considering secondary causes of osteoporosis. Finally, we discuss treatment of the more severe cases of bone disease, while outlining the caveats and gaps in our knowledge.
McComsey
Grace A
GA
Department of Pediatrics and Medicine, Case Western Reserve University, Cleveland, Ohio, USA. gam9@case.edu
Tebas
Pablo
P
Shane
Elizabeth
E
Yin
Michael T
MT
Overton
E Turner
ET
Huang
Jeannie S
JS
Aldrovandi
Grace M
GM
Cardoso
Sandra W
SW
Santana
Jorge L
JL
Brown
Todd T
TT
D000368:Aged; D000369:Aged, 80 and over; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects / Q000502:physiology; D001847:Bone Diseases / Q000139:chemically induced* / Q000453:epidemiology*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment
D019380:Anti-HIV Agents