More than osteoporosis

Abstract

Purpose of Review The interaction between fall and fracture risk factors is an area of increasing clinical relevance, but little is known about the age-specific issues in bone health unique to HIV-infected adults. This review will focus on what is known about falls and fall risk factors among HIV-infected adults, and then review the association between decreased muscle, increased adiposity, and frailty with both low BMD and falls Recent Findings The rate of falls among middle-aged HIV-infected adults is similar to that of HIV-uninfected adults 65 years and older. Many of the clinical factors that contribute to low BMD overlap with risk factors for falls, resulting in a high risk of a serious fall among older adults with the greatest risk for a fracture. Low muscle mass, increased adiposity and metabolic syndrome, physical function impairment and frailty, common among older HIV-infected adults, contribute to an increased risk for low BMD and falls, and subsequently, may increase the risk of fracture among HIV-infected older adults. Summary Interventions with dual benefit on reducing fall risk and improving BMD are likely to have the greatest impact on fracture prevention in the older, HIV-infected adult.

Bone Mineral Density Declines Twice as Quickly Among HIV-Infected Women Compared With Men

“…Importantly, low BMD is one of several risk factors for fracture. Therefore, the interventions likely to have the greatest impact in this aging population are those that both attenuate BMD losses and minimize fracture risk through reduced falls 37 .…”

Objective impairments of gait and balance in adults living with HIV-1 infection: a systematic review and meta-analysis of observational studies

“…Low appendicular muscle mass is prevalent in PLHIV and associated with functional impairment [ 72 ]. However, a decline in the ability of muscles to produce strength and power (dynapenia) might have a bigger contribution to functional decline in the elderly and is associated with poor chair-rise-time [ 73 ] Intra-muscular impairments, including fatty muscle infiltration, and low central activation are reported in PLHIV [ 29 , 35 , 74 ] and premature expression of genes associated with muscle aging is upregulated in PLHIV [ 75 ]. Grip strength might correlate with dynapenia in the elderly [ 76 ], and an accelerated decline in grip strength has been reported in PLHIV [ 77 ].…”

“…Of further concern is that PLHIV are four times more at risk of fractures due to accelerated bone demineralization [ 27 ] and sarcopenia [ 28 ], and the proposed interplay between these conditions [ 29 ]. Low bone mineral density and sarcopenia are associated with balance problems and falls [ 28 , 30 ].…”

Fall History and Associated Factors Among Adults Living With HIV-1 in the Cape Winelands, South Africa: An Exploratory Investigation

“…Falls are common in people with HIV-1 (PWH) [1, 2]. Falls pose a particular concern in PWH because of reduced bone mineral density (BMD), owing to metabolic changes, bone cell infection, and highly active antiretroviral therapy (ART)–induced bone loss [3, 4].…”

“…Although HIV-related factors are associated with low BMD [3], published information suggests that HIV-specific variables may not be associated with fall risk [1, 5, 10]. Similarly, substance abuse–related factors (alcohol use, illegal drugs) have not shown an association with falls in PWH [2]. However, PWH have a high prevalence of various factors traditionally associated with falls.…”