Bone Quality in Relation to HIV and Antiretroviral Drugs

Abstract

Purpose of review: People living with HIV (PLWH) are at an increased risk for osteoporosis, a disease defined by the loss of bone mineral density (BMD) and deterioration of bone quality, both of which independently contribute to an increased risk of skeletal fractures. While there is an emerging body of literature focusing on the factors that contribute to BMD loss in PLWH, the contribution of these factors to bone quality changes are less understood. The current review summarizes and critically reviews the data describing the effects of HIV, HIV disease-related factors, and antiretroviral drugs (ARVs) on bone quality.

Recent findings: The increased availability of high-resolution peripheral quantitative computed tomography has confirmed that both HIV infection and ARVs negatively affect bone architecture. There is considerably less data on their effects on bone remodeling or the composition of bone matrix. Whether changes in bone quality independently predict fracture risk, as seen in HIV-uninfected populations, is largely unknown. The available data suggests that bone quality deterioration occurs in PLWH. Future studies are needed to define which factors, viral or ARVs, contribute to loss of bone quality and which bone quality factors are most associated with increased fracture risk.

Keywords: Bone mineral density; Bone quality; Matrix composition; Microarchitecture; Remodeling.

Figure 1:

Bone quality schematic. Bone quality is defined as factors, such as bone remodeling rates, bone architecture, and matrix composition, that can affect dual energy x-ray absorptiometry measures of bone mineral density (BMD) and independently contribute to skeletal fracture risk. The current review focuses on the effects of HIV and ARVs on the factors that make up bone quality. A variety of other non-skeletal risk factors also contribute to fracture risk, such as muscle strength and falls, that are outside of the scope of the current review.