[Metabolic bone disorders in HIV patients]

The life expectancy of HIV patients has increased dramatically since the introduction of combination antiretroviral therapy. This led to an increase in the incidence of non-AIDS related diseases, such as liver diseases, malignancies and metabolic disorders. Increased incidence of osteoporosis and bone fractures was found in HIV patients compared to the general population. The causes were multifactorial, combining traditional risk factors (such as age, sex, low weight, smoking, steroid treatment, vitamin D deficiency), with risk factors associated with the viral infection itself (increased bone loss and decreased bone formation), and to a lesser extent from the antiretroviral treatment itself. An association between bone density loss and antiviral drugs such as Tenofovir, and different protease inhibitors, was found in several studies, but no definite evidence of an increased risk of bone fractures was found. Current American guidelines recommend screening for low bone density only HIV patients who are over 50 years of age with a risk factor for osteoporosis. European guidelines recommend screening all HIV patients older than 50 years. HIV patients at risk for fractures should be treated according to local guidelines in the general population. Currently, no recommendations exist to change any specific antiretroviral therapy in case of osteoporosis, unless there are specific circumstances.