Osteoporosis and HIV Infection

Abstract

Life expectancy of people living with HIV (PLWH) is now close to that of the HIV-uninfected population. As a result, age-related comorbidities, including osteoporosis, are increasing in PLWH. This narrative review describes the epidemiology of bone fragility in PLWH, changes of bone features over the course of HIV infection and their determinants, as well as the available evidence regarding the management of osteoporosis in PLWH. The risk of fracture is higher and increases about 10 years earlier compared to the general population. The classical risk factors of bone fragility are very widespread and are major determinants of bone health in this population. The majority of bone loss occurs during virus replication and during immune reconstitution at antiretroviral therapies (ART) initiation, which both increase osteoclast activity. Abnormalities in bone formation and mineralization have also been shown in histomorphometric studies in untreated PLWH. Measurement of bone mineral density (BMD) is the first line tool for assessing fracture risk in postmenopausal women, men above 50 years, and other HIV-infected patients with clinical risk factors for osteoporosis. FRAX underestimates fracture probability in PLWH. In case of indication for anti-osteoporotic drug, bisphosphonates remain the reference option. Calcium and vitamin D supplementation should be considered as ART initiation, since it may attenuate bone loss at this stage. Bone-protective ART regimens improve BMD compared to other regimens, but to a lesser extent than bisphosphonate, and without available data on their influence on the incidence of fracture.

Problems undermining the health-related quality of life of people living with HIV in Spain: a qualitative study to inform the development of a novel clinic screening tool

“…Furthermore, PLHIV have a greater multimorbidity burden than the general population, with comorbidities occurring at younger ages [ 2 ]. They are at elevated risk of some comorbidities including osteoporosis, diabetes, cardiovascular disease, and chronic kidney disease [ 2 , 16 – 18 ]. HIV remains highly stigmatised, and discrimination and other manifestations of stigma contribute to the social isolation and mental health problems that are commonly reported by PLHIV [ 19 – 22 ].…”

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

“…Different factors have been shown to influence the structure of the bones in PLWHIV and can be associated with increases in both mortality and morbidity. Other factors that lead to increases in mortality and morbidity in PLWHIV and fractures are non-AIDS malignancies, diabetes, dyslipidemia, chronic kidney diseases, lung disease and cardiovascular diseases [ 25 ]. Therefore, different factors can lead to a decrease in bone mass in PLWHIV, as stated in Figure 2 .…”

Frailty and prefrailty in people living with HIV, with focus on women living with HIV

“…27 Depression often leads to discontinuation of antiretroviral treatment and detectable HIV-1 RNA and not being on antiretroviral treatment increase the risk of frailty. [28][29][30] Although the overall protective effect of ART on the risk of AIDS and mortality must be emphasized, some side effects of antiretroviral drugs are risk factors for frailty in PLWH. Reduction in bone mineral density has been reported with the use of ART, particularly tenofovir disoproxil (TDF), efavirenz (EFV) and protease inhibitors (PIs), especially in association with hormonal disturbances and malnutrition.…”