Bone mineral density in HIV-infected women taking antiretroviral therapy: a systematic review

Abstract

SummaryThere is a high prevalence of osteoporosis in HIV-infected patients. Initially described in HIVpositive men, studies have also demonstrated a high prevalence of osteoporosis in HIV-infected women. It would appear that antiretroviral therapy (ART) plays an important role in the pathogenesis of osteoporosis in HIV-infected patients, although little is known about its importance in relation to osteoporosis and fractures in HIV-positive women. The aim of this systematic review was to evaluate the frequency of bone loss, bone mineral density (BMD) and fractures in HIVpositive women taking ART or protease inhibitors (PI). After screening 597 citations from the databases of PubMed, EMBASE and Lilacs, five studies were selected for the review. A difference was demonstrated of over 3% in the BMD at the femoral neck of HIV-positive women taking PI/ ART. No difference was registered in the BMD at the lumbar spine between users and non-users of PI/ART. The lack of studies has made it impossible to reach any conclusion regarding the occurrence of fractures. Arq Bras Endocrinol Metab. 2010;54(2):133-42 Keywords HIV; osteoporosis; fractures, bone; bone density; highly active antiretroviral therapy; systematic review Sumário A prevalência de osteoporose é elevada em indivíduos infectados pelo HIV. Inicialmente descrita em homens HIV-positivos, estudos demonstraram alta prevalência de osteoporose também em mulheres HIV-positivas. A terapia antirretroviral parece exercer papel importante na patogênese da osteoporose dos indivíduos com HIV. Pouco se sabe sobre sua importância para a osteoporose e fraturas nas mulheres HIV-positivas. Esta revisão objetivou avaliar a frequência de perda de massa óssea, densidade mineral óssea (DMO) e fraturas em mulheres HIV-positivas em uso de terapia antirretroviral (TARV) ou inibidores de protease (IP). Após busca nos bancos de dados PubMed, EMBASE e Lilacs, de 597 citações, cinco estudos permaneceram na revisão. Demonstrou-se haver uma diferença superior a 3% na DMO no colo do fêmur de mulheres HIV-positivas em uso de IP/TARV. Não se evidenciou diferença na DMO da coluna lombar entre usuárias e não usuárias de IP/TARV. A escassez de estudos impossibilitou qualquer conclusão sobre a ocorrência de fraturas. Arq Bras Endocrinol Metab. 2010;54(2):133-42

Bone Density and Fractures in HIV-infected Postmenopausal Women: A Systematic Review

“…The evidence on the effect of ART on bone density in HIV-infected women has also been explored (Carvalho, Gelenske, Bandeira, & Albuquerque, 2010). However, to date, the quality of the literature on menopause-associated changes involving bone in HIV-infected women has not been systematically appraised.…”

An increased risk of osteoporosis in a HIV-infected patient in the era of HAART. Case report analysis

“…The studies of prevalence of osteoporosis, initially described in HIV-positive men, have also demonstrated a high prevalence in HIV-infected women [11]. Although little is known about its importance in relation to osteoporosis and fractures in HIV-positive women [11].…”

“…Although little is known about its importance in relation to osteoporosis and fractures in HIV-positive women [11].…”

Osteoporosis and vitamin D deficiency in HIV-infected patients: Genetic and classical factors compared to the HIV-associated ones – Review

“…Since the beginning of HIV pandemics increased prevalence of osteopenia and/or osteoporosis among infected individuals has been observed [2,5,8]. Prior to the antiretroviral treatment era, observations of this phenomenon had been performed on small groups of survivors, with osteoporosis diagnosed in a low percentage of patients, mainly young men.…”

“…However, this routine follow-up does not include bone mineralization disturbance. Scale of the bone mineralization disturbances among HIV positive patients remain unknown, however international data suggest that the frequency and severity of this problem is increasing [4,5].…”