New guidelines for osteoporosis treatment for people living with HIV
Screening for bone fracture risk should be a routine part of HIV care, as recommended by new guidelines published in the journal of Clinical Infectious Diseases. Evidence shows that low bone mineral density (osteoporosis) and fragility fractures occur more frequently in people living with HIV.
Several US-based studies conclude that people living with HIV have a 60 percent higher risk of fractures of the spine, hip and wrist, than the general population. It is unclear whether the HIV infection itself causes bone mineral loss or whether it is caused by treatment. What is known is that bone mineral density declines by two to six percent in the first two years after initiating antiretroviral treatment.
The first prevention measures for osteoporosis are dietary and lifestyle changes, including regular exercise, not smoking and reducing alcohol intake. Screening people to identify their risk of fractures is needed to provide preventive treatment. The expert panel made therefore several recommendations for screening, monitoring and managing people with HIV at risk for fragility fracture. The guidelines recommend that:
- People at high risk of fragility fractures should be evaluated using Dual-Energy X-Ray Absorptiometry (DXA) Screening. This includes men 50 years and older, postmenopausal woman, people with a history of fragility fractures.
- Men aged 40-49 and premenopausal women 40 years and older can be assessed for fracture risks using the FRAX scoring system – a scoring system based on the person’s lifestyle and medical history – every two to three years.
- In countries, where DXA screening is not widely available, FRAX screening should be used to identify high fracture risk people.
- ART treatment should be provided according to the guidelines, but treatment should be reassessed for people with low bone mineral density or osteoporosis.
As the population of people living with HIV ages, bone mineral loss, associated with significant long-term morbidity, is becoming a more serious problem. Guidelines regarding screening, monitoring and management of people living with HIV for bone disease are therefore needed.