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Measuring Frailty in HIV-infected Individuals. Identification of Frail Patients is the First Step to Amelioration and Reversal of Frailty
Published on: July 24, 2013
People living with HIV and fracture risk
1Department of Clinical Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil. premaor@medicina.ufmg.br.
Insights
People living with HIV (PLHIV) face a higher risk of osteoporosis and fractures. This review covers bone disease in PLHIV, focusing on risk assessment and prevention strategies for better bone health.
Area of Science:
- Bone Metabolism and HIV
- Epidemiology of Fractures
- Pharmacology of Bone Disease
Background:
- People living with HIV (PLHIV) now have near-normal life expectancy due to antiretroviral therapy.
- Increased lifespan in PLHIV is associated with a higher prevalence of chronic diseases, including bone disease.
- PLHIV exhibit an elevated risk of osteoporosis and fractures compared to the general population.
Purpose of the Study:
- To review the epidemiology and pathophysiology of bone disease and fractures in PLHIV.
- To discuss fracture risk assessment and prevention strategies for PLHIV.
- To synthesize current understanding of bone health challenges in the context of HIV.
Main Methods:
- Literature review of studies on HIV, bone disease, and fractures.
- Analysis of epidemiological data concerning fracture risk in PLHIV.
- Examination of pathophysiological mechanisms contributing to bone loss in HIV.
Main Results:
- Bone disease and fractures are significant concerns for PLHIV, with increased incidence of osteoporosis and vertebral fractures.
- Causes are multifactorial, involving HIV-specific factors like antiretroviral drugs and chronic inflammation, alongside traditional fracture risks.
- Current guidelines suggest FRAX for fracture probability assessment in PLHIV over 40 and bone mineral density measurement for high-risk individuals.
Conclusions:
- Bone health is a critical issue for the aging PLHIV population.
- Comprehensive assessment and management of fracture risk are essential for PLHIV.
- Further research is needed on fracture outcomes with treatments like bisphosphonates in PLHIV.
Abstract:
PLHIV have an increased risk of osteoporosis and fractures when compared with people of the same age and sex. In this review, we address the epidemiology and the pathophysiology of bone disease and fractures in PLHIV. The assessment of fracture risk and fracture prevention in these subjects is also discussed. The spectrum of HIV-associated disease has changed dramatically since the introduction of potent antiretroviral drugs. Today, the survival of people living with HIV (PLHIV) is close to that of the general population. However, the longer life-span in PLHIV is accompanied by an increased prevalence of chronic diseases. Detrimental effects on bone health are well recognised, with an increased risk of osteoporosis and fractures, including vertebral fractures, compared to the general population. The causes of bone disease in PLHIV are not fully understood, but include HIV-specific risk factors such as use of antiretrovirals and the presence of chronic inflammation, as well as traditional risk factors for fracture. Current guidelines recommend the use of FRAX to assess fracture probability in PLHIV age ≥ 40 years and measurement of bone mineral density in those at increased fracture risk. Vitamin D deficiency, if present, should be treated. Bisphosphonates have been shown to increase bone density in PLHIV although fracture outcomes are not available.
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