Aging with HIV: osteoporosis and fractures

Osteoporosis remains an important focus of contemporary research in HIV, with co-morbidities and mortality from non-AIDS illnesses now a major barrier to normal lifespan in many populations living with HIV. This review outlines the major recent advances in our understanding of osteoporosis and fractures in those living with HIV and identifies remaining gaps in our knowledge of this complex but increasingly important aspect of aging research in HIV.

Low bone mineral density (BMD), osteoporosis and fractures are all more common in those living with HIV, with recent data pointing for the first time to causal links between low BMD and fractures in those with HIV. The natural history and pathogenesis of osteoporosis in HIV and the epidemiology of fractures in this vulnerable population differ considerably from the general population, with both disease-related and treatment-related factors both contributing to its development through alterations in bone turnover and defects in bone architecture.

Only through a greater understanding of the pathogenesis can appropriate screening and preventive measures be taken in people living with HIV to preserve bone health as they age.