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Bone loss in patients with HIV infection
Julien Paccou1, Nathalie Viget, Isabelle Legrout-Gérot
1Département universitaire de rhumatologie, hôpital Roger-Salengro, CHRU de Lille, 59037 Lille cedex, France. julienpaccou@yahoo.fr
Joint Bone Spine
|December 1, 2009
Summary
Antiretroviral drugs improve HIV prognosis but increase bone loss risk. HIV patients show low bone density, necessitating interventions like bisphosphonates to manage bone insufficiency and fractures.
Area of Science:
- Infectious Diseases
- Endocrinology
- Orthopedics
Background:
- Antiretroviral therapy has significantly improved HIV prognosis and patient survival.
- Longer survival is linked to increased prevalence of bone complications like decreased bone mineral density (BMD) and insufficiency fractures.
- Osteoporosis affects 15% and osteopenia 52% of HIV patients, as per a meta-analysis.
Purpose of the Study:
- To investigate the relationship between HIV infection and bone health.
- To identify factors contributing to bone loss in HIV patients.
- To evaluate therapeutic strategies for bone insufficiency in this population.
Main Methods:
- Review of meta-analysis data (1966-2005) on bone absorptiometry in HIV patients.
- Analysis of longitudinal studies examining antiretroviral therapy's impact on bone loss.
- Assessment of bone resorption and formation markers.
- Consideration of conventional and HIV-specific risk factors for osteoporotic fractures.
Main Results:
- Longitudinal studies found no direct link between antiretroviral therapy and bone loss.
- Data suggest a "bone remodeling uncoupling" with increased resorption and decreased formation markers.
- HIV-associated factors include malnutrition, hypogonadism, and calcium/phosphate metabolism disorders.
Conclusions:
- HIV infection itself, alongside other factors, contributes to bone insufficiency.
- Bisphosphonate therapy, such as alendronate with vitamin D and calcium, is effective for improving BMD in patients with established bone insufficiency.
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