Recommendations for Evaluation and Management of Bone Disease in HIV

Abstract

Thirty-four human immunodeficiency virus (HIV) specialists from 16 countries contributed to this project, whose primary aim was to provide guidance on the screening, diagnosis, and monitoring of bone disease in HIV-infected patients. Four clinically important questions in bone disease management were identified, and recommendations, based on literature review and expert opinion, were agreed upon. Risk of fragility fracture should be assessed primarily using the Fracture Risk Assessment Tool (FRAX), without dual-energy X-ray absorptiometry (DXA), in all HIV-infected men aged 40-49 years and HIV-infected premenopausal women aged ≥40 years. DXA should be performed in men aged ≥50 years, postmenopausal women, patients with a history of fragility fracture, patients receiving chronic glucocorticoid treatment, and patients at high risk of falls. In resource-limited settings, FRAX without bone mineral density can be substituted for DXA. Guidelines for antiretroviral therapy should be followed; adjustment should avoid tenofovir disoproxil fumarate or boosted protease inhibitors in at-risk patients. Dietary and lifestyle management strategies for high-risk patients should be employed and antiosteoporosis treatment initiated.

A Single-dose Zoledronic Acid Infusion Prevents Antiretroviral Therapy–induced Bone Loss in Treatment-naive HIV-infected Patients: A Phase IIb Trial

“…Mean lumbar spine ; P < .001; Figure 3A). ZOL led to an 8% increase in lumbar spine BMD at 12 weeks relative to placebo (mean difference, 0.101 g/cm 2 Figure 3B). Similar trends were observed for BMD in the hip and femoral neck (Supplementary Figure 1).…”

“…Among the metabolic complications of chronic HIV infection is skeletal deterioration [2]. Osteopenia prevalence in HIV-infected cohorts ranges from 22% to 71%, with rates of osteoporosis varying from 3% to 33% [3].…”

“…The skeletal effects of ART, although varied in magnitude, appear to be universal to all ART types including tenofovir alafenamide (TAF)-containing and tenofovir disoproxil fumarate (TDF)-sparing regimens [5][6][7][8][9][10]. Losses of up to 6% in bone mineral density (BMD) were observed with earlier regimens within 1-2 years of ART initiation [2]. With TAF, an average loss in BMD of 0.66% at the hip and 1.30% at the lumbar spine was observed after 48 weeks in ARTnaive, HIV-infected patients.…”

Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome in Older Adults

“…31 Tenofovir alafenamide is associated with lower rates of bone demineralization than is tenofovir disoproxil fumarate. 28 Neurocognitive deficits are significantly more common in HIV-infected individuals and range from asymptomatic neurocognitive impairment to HIV-associated dementia (HAD).…”

Bone Disease in HIV: Recommendations for Screening and Management in the Older Patient

“…HIV infection is not currently included as a secondary risk factor in the FRAX Ò calculator tool. Because of the observed increase in osteoporosis and fractures in people with HIV infection, some experts believe HIV should be considered to be a secondary cause of osteoporosis and fragility fractures [10,11].…”