title: Osteoporosis in postmenopausal women living with HIV.
abstract: The widespread availability of effective antiretroviral therapy (ART) has transformed HIV from a life-limiting condition to one with near-normal life expectancy. HIV is associated with an increased risk of osteopenia and osteoporosis, with people living with HIV (PLHIV) potentially experiencing these conditions at a younger age than their HIV-negative counterparts. The mechanisms driving bone disease in HIV are complex and include: an increased prevalence of traditional risk factors; other comorbid conditions; and HIV-associated factors such as viral effects, systemic inflammation, and ART-related factors. One-third of PLHIV in the United Kingdom are female, and increasing numbers of women living with HIV (WLHIV) are reaching menopausal age. Oestrogen decline in the context of an elevated background risk of poor bone health results in WLHIV being at greater risk of osteoporosis than women without HIV. European HIV guidelines therefore recommend routine screening of postmenopausal WLHIV using FRAX©for clinical risk factors, with or without bone mineral density scanning. Data support the use of calcium and vitamin D supplementation, and bisphosphonates in the treatment of osteoporosis in PLHIV. Additionally, some patients with confirmed osteoporosis may benefit from a switch to an ART agent with a better bone safety profile. However, there remains a notable paucity of data on HIV and menopause, including the impact of hormone replacement therapy on the bone health of WLHIV. In conclusion, it is important that clinicians are aware that postmenopausal WLHIV are a group at particular risk of bone disease, who require proactive screening and advice about preventative measures.
authors.affiliation: The Lawson Unit, Brighton & Sussex University Hospitals, Eastern Rd, Brighton, BN2 5BE, UK. Electronic address: fionnuala.finnerty@bsuh.nhs.uk.
authors.forename: Fionnuala
authors.initials: F
authors.lastname: Finnerty
authors.affiliation: Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK. Electronic address: kwb@mrc.soton.ac.uk.
authors.forename: Karen
authors.initials: K
authors.lastname: Walker-Bone
authors.affiliation: Research Department of Infection and Population Health, University College London, Mortimer Market Centre, Off Capper Street, London, WC1E 6JB, UK. Electronic address: s.tariq@ucl.ac.uk.
authors.forename: Shema
authors.initials: S
authors.lastname: Tariq
mesh_terms: D015519:Bone Density / Q000502:physiology; D002136:Calcium, Dietary; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008593:Menopause; D015663:Osteoporosis, Postmenopausal / Q000150:complications* / Q000188:drug therapy; D017698:Postmenopause; D012307:Risk Factors; D006113:United Kingdom
chemical_list: D002136:Calcium, Dietary; D004164:Diphosphonates
keywords: HIV; Menopause; Osteoporosis; Women