Bone alterations associated with HIV

Area of Science:

• Bone Metabolism and HIV Research
• Osteoporosis and Public Health

Background:

• HIV infection and antiretroviral therapy (ART) are associated with reduced bone mineral density (BMD).
• This bone loss increases fracture risk, particularly concerning for aging individuals with HIV and HIV-infected youth who may not achieve peak BMD.
• The causes of bone disease in HIV are multifactorial, involving the virus, immunosuppression, ART, and traditional osteoporosis risk factors.

Purpose of the Study:

• To highlight the association between HIV, ART, and decreased BMD.
• To emphasize the increased fracture risk in the HIV-positive population.
• To discuss the challenges in elucidating bone disease causes and recommend management strategies.

Main Methods:

• Review of current evidence linking HIV infection and ART to bone density and fracture risk.
• Analysis of contributing factors to bone disease in HIV, including viral, immunological, therapeutic, and lifestyle elements.
• Evaluation of screening and treatment approaches for osteoporosis in HIV-positive individuals.

Main Results:

• Consistent association between HIV/ART and decreased BMD, leading to higher fracture risk.
• Potential failure of HIV-infected children and youth to attain peak BMD, elevating lifetime fracture risk.
• Bisphosphonate therapy demonstrates safety and efficacy in managing fractures and elevated fracture risk in the HIV+ population.

Conclusions:

• Healthcare providers must recognize the elevated risk of low BMD and fractures in people with HIV.
• Appropriate screening for osteoporosis is recommended for HIV-positive patients with risk factors.
• Bisphosphonates are a safe and effective treatment option for fractures or high fracture risk in this population.