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Review
. 2023 Mar 19;11(3):789.
doi: 10.3390/microorganisms11030789.

Bone Health in People Living with HIV/AIDS: An Update of Where We Are and Potential Future Strategies

Musaab Ahmed  1   2 , Dushyant Mital  3 , Nuha Eljaili Abubaker  4 , Maria Panourgia  5 , Henry Owles  5 , Ioanna Papadaki  6 , Mohamed H Ahmed  5   7
Affiliations
Review

Bone Health in People Living with HIV/AIDS: An Update of Where We Are and Potential Future Strategies

Musaab Ahmed et al. Microorganisms. .

Abstract

The developments in Human Immunodeficiency Virus (HIV) treatment and in the care of people living with HIV (PLWHIV) and Acquired Immunodeficiency Syndrome (AIDS) over the last three decades has led to a significant increase in life expectancy, on par with HIV-negative individuals. Aside from the fact that bone fractures tend to occur 10 years earlier than in HIV-negative individuals, HIV is, per se, an independent risk factor for bone fractures. A few available antiretroviral therapies (ARVs) are also linked with osteoporosis, particularly those involving tenofovir disoproxil fumarate (TDF). HIV and hepatitis C (HCV) coinfection is associated with a greater risk of osteoporosis and fracture than HIV monoinfection. Both the Fracture Risk Assessment Tool (FRAX) and measurement of bone mineral density (BMD) via a DEXA scan are routinely used in the assessment of fracture risk in individuals living with HIV, as bone loss is thought to start between the ages of 40 and 50 years old. The main treatment for established osteoporosis involves bisphosphonates. Supplementation with calcium and vitamin D is part of clinical practice of most HIV centers globally. Further research is needed to assess (i) the cut-off age for assessment of osteoporosis, (ii) the utility of anti-osteoporotic agents in PLWHIV and (iii) how concomitant viral infections and COVID-19 in PLWHIV can increase risk of osteoporosis.

Keywords: HIV; bisphosphante; osteoprosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Results of the search of the literature.
Figure 2
Figure 2
Different factors that may lead to low BMD in PLWHIV.
Figure 3
Figure 3
Diagram showing the proposed steps for the management of osteoporosis in acute and chronic HIV.
See this image and copyright information in PMC

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