title: Management of bone mineral density in HIV-infected patients.
abstract: BACKGROUND
  Loss of bone mineral density is an emerging problem in persons living with HIV infection. Earlier and more rapid bone demineralization has been attributed not only to the high prevalence of traditional risk factors, but also to specific HIV-related factors. The aim of this guidance is to stimulate an appropriate management of osteoporosis in this population, to identify patients at risk and to better manage them.
  
  
  METHODS
  Appropriate screening of HIV-infected subjects to identify those at risk for bone fractures is described, as well as the recommended interventions. American and European recommendations in HIV-infected and non-infected populations were considered. As the etiology of bone loss is multifactorial, many factors have to be addressed. Overall, recommendations on traditional risk factors are the same for HIV-infected and non-HIV-infected subjects. However, we should consider some specific factors in the HIV-infected population, including an appropriate antiretroviral therapy in patients with low bone mineral density, and probably novel strategies that could provide an additional benefit, such as anti-inflammatory drugs, although data supporting this approach are scant.
  
  
  CONCLUSIONS
  Some personal opinions are highlighted on the management of bone health in HIV-infected subjects, mainly on the use of FRAX(®) score and DXA scans. In addition, the need to implement new strategies to delay demineralization is remarked upon.
authors.affiliation: a Unitat VIH, Fundació Lluita contra la SIDA, Hospital Germans Trias i Pujol , Universitat Autònoma de Barcelona , Badalona , Barcelona , Spain.|b Universitat de Vic-Universitat Central de Catalunya , Barcelona , Spain.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Negredo
authors.affiliation: a Unitat VIH, Fundació Lluita contra la SIDA, Hospital Germans Trias i Pujol , Universitat Autònoma de Barcelona , Badalona , Barcelona , Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Bonjoch
authors.affiliation: a Unitat VIH, Fundació Lluita contra la SIDA, Hospital Germans Trias i Pujol , Universitat Autònoma de Barcelona , Badalona , Barcelona , Spain.|b Universitat de Vic-Universitat Central de Catalunya , Barcelona , Spain.|c Fundació IrsiCaixa, Hospital Germans Trias i Pujol , Universitat Autònoma de Barcelona , Badalona , Barcelona , Spain.
authors.forename: Bonaventura
authors.initials: B
authors.lastname: Clotet
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D004164:Diphosphonates / Q000627:therapeutic use; D019468:Disease Management; D050723:Fractures, Bone / Q000517:prevention & control; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
chemical_list: D019380:Anti-HIV Agents; D000893:Anti-Inflammatory Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: Bone mineral density; HIV; Osteoporosis; management