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Osteoporosis in HIV

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Osteoporosis in HIV, Bone Loss in HIV

  • See Also
  1. Osteoporosis
  2. Osteoporosis Secondary Causes
  3. Medication Causes of Osteoporosis
  4. Osteoporosis Evaluation
  5. Osteoporosis Management
  6. Endocrine Manifestations of HIV
  7. HIV Complications
  • Pathophysiology
  1. HIV is associated with higher Fracture risk (up to RR 1.5)
  2. Fragility Fractures are seen 10 years earlier in HIV than non-HIV patients with similar risks
  • Causes
  1. Results from chronic inflammation causing increased Osteoclast activity
  2. Antiretroviral therapy also increases risk (esp. in first 1-2 years)
    1. Tenofovoir disoproxil fumarate (DPF) decreases BMD 2-6%
  3. Other risks
    1. Comorbid Hepatitis CVirus Infection
    2. Underweight (low Body Mass Index)
    3. Smoking
    4. Alcohol Use Disorder
  • Evaluation
  1. See Osteoporosis Screening (e.g. DEXA Scan) as indicated
  • Management
  1. See Osteoporosis Management
  2. Lifestyle modification (Smoking Cessation, limit Alcohol use, maintain healthy weight)
  3. Consider alternatives to Tenofovoir disoproxil fumarate (DPF)
    1. Tenofovir Alafenamide (TAF)
    2. Cabotegravir/Rilpivirine (Cabenuva)
    3. Dolutegravir/Rilpivirine (Juluca)
    4. Dolutegravir/Lamivudine (Triumeq)
  • Prevention
  1. See Osteoporosis Prevention
  • References
  1. Chu (2017) Am Fam Physician 96(3): 161-9 [PubMed]
  2. Jaqua (2026) Am Fam Physician 113(1): 71-9 [PubMed]