Osteoporosis in HIV

Aka: Osteoporosis in HIV, Bone Loss in HIV

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II. 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

III. 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

IV. Evaluation

  1. See Osteoporosis Screening (e.g. DEXA Scan) as indicated

V. 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)

VI. Prevention

  1. See Osteoporosis Prevention

VII. References

  1. Chu (2017) Am Fam Physician 96(3): 161-9 [PubMed]
  2. Jaqua (2026) Am Fam Physician 113(1): 71-9 [PubMed]

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