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BONE DISEASE IN HIV INFECTION: A PRACTICAL REVIEW AND RECOMMENDATIONS FOR HIV CARE PROVIDERS
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Case Western Reserve University. Departments of Pediatrics and Medicine. Cleveland, Ohio, USA.
University of Pennsylvania. Department of Medicine. Philadelphia, USA.
Columbia University. Department of Medicine. College of Physicians and Surgeons. New York, NY, USA.
Columbia University. Department of Medicine. College of Physicians and Surgeons. New York, NY, USA.
Washington University School of Medicine. Department of Medicine. St. Louis, Missouri, USA.
University of California at San Diego. Department of Pediatrics. San Diego, USA.
Childrens Hospital Los Angeles. Department of Pediatrics. Los Angeles, California, USA.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.
University of Puerto Rico. School of Medicine. Department of Medicine. San Juan, Puerto Rico.
Johns Hopkins University. School of Medicine. Department of Medicine. Baltimore, Maryland, USA.
University of Pennsylvania. Department of Medicine. Philadelphia, USA.
Columbia University. Department of Medicine. College of Physicians and Surgeons. New York, NY, USA.
Columbia University. Department of Medicine. College of Physicians and Surgeons. New York, NY, USA.
Washington University School of Medicine. Department of Medicine. St. Louis, Missouri, USA.
University of California at San Diego. Department of Pediatrics. San Diego, USA.
Childrens Hospital Los Angeles. Department of Pediatrics. Los Angeles, California, USA.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.
University of Puerto Rico. School of Medicine. Department of Medicine. San Juan, Puerto Rico.
Johns Hopkins University. School of Medicine. Department of Medicine. Baltimore, Maryland, USA.
Abstract
Low bone mineral density (BMD) is prevalent in human immunodeficiency virus (HIV)-infected subjects. Initiation of antiretroviral therapy is associated with a 2%-6% decrease in BMD over the first 2 years, a decrease that is similar in magnitude to that sustained during the first 2 years of menopause. Recent studies have also described increased fracture rates in the HIV-infected population. The causes of low BMD in individuals with HIV infection appear to be multifactorial and likely represent a complex interaction between HIV infection, traditional osteoporosis risk factors, and antiretroviral-related factors. In this review, we make the point that HIV infection should be considered as a risk factor for bone disease. We recommend screening patients with fragility fractures, all HIV-infected post-menopausal women, and all HIV-infected men ⩾50 years of age. We also discuss the importance of considering secondary causes of osteoporosis. Finally, we discuss treatment of the more severe cases of bone disease, while outlining the caveats and gaps in our knowledge.
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