Diagnosis, prevention, and treatment of bone fragility in people living with HIV: a position statement from the Swiss Association against Osteoporosis.

Biver, E; Calmy, A; Aubry-Rozier, B; Birkhäuser, M; Bischoff-Ferrari, H A; Ferrari, S; Frey, D; Kressig, R W; Lamy, O; Lippuner, Kurt; Suhm, N; Meier, C (2019). Diagnosis, prevention, and treatment of bone fragility in people living with HIV: a position statement from the Swiss Association against Osteoporosis. Osteoporosis international, 30(5), pp. 1125-1135. Springer-Verlag 10.1007/s00198-018-4794-0

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Life expectancy of people living with HIV (PLWH) is reaching similar length as in the general population. Accordingly, age-related comorbidities, including osteoporosis, are increasing. Fracture risk is higher and increases approximately 10 years earlier in PLWH. Classical risk factors of bone fragility are highly prevalent in PLWH but factors specific for HIV infection itself and the type of antiretroviral therapy (ART) (triple combination antiretroviral therapy) regimen (especially tenofovir and protease inhibitors) also contribute to bone loss. The majority of bone loss occurs during virus activity and at initiation of ART (immune reconstitution) and is associated with an increase of bone resorption (upregulation RANKL). Recent data indicate that calcium and vitamin D supplements as ART initiation lower BMD loss. The reduction of tenofovir plasma concentrations with tenofovir alafenamide attenuates BMD loss but it remains unknown whether it will contribute to reduce fracture risk. Hence, special considerations for the management of bone fragility in PLWH are warranted. Based on the current state of epidemiology and pathophysiology of osteoporosis in PLWH, we provide the consensus of the Swiss Association against Osteoporosis on best practice for diagnosis, prevention, and management of osteoporosis in this population. Periodic assessment of fracture risk is indicated in all HIV patients and general preventive measures should be implemented. All postmenopausal women, men above 50 years of age, and patients with other clinical risk for fragility fractures qualify for BMD measurement. An algorithm clarifies when treatment with bisphosphonates and review of ART regimen in favour of more bone-friendly options are indicated.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Osteoporosis

UniBE Contributor:

Lippuner, Kurt

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0937-941X

Publisher:

Springer-Verlag

Language:

English

Submitter:

Romain Perrelet

Date Deposited:

10 Dec 2019 10:36

Last Modified:

10 Dec 2019 10:36

Publisher DOI:

10.1007/s00198-018-4794-0

PubMed ID:

30603840

Uncontrolled Keywords:

Bone fragility Diagnosis HIV Management Osteoporosis Prevention

URI:

https://boris.unibe.ch/id/eprint/135447

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