HIV-associated osteopenia and osteoporosis

Purpose of review Highly active antiretroviral therapy has radically changed the course of human immunodeficiency virus (HIV) infection. HIV+ patients now survive long enough to manifest long-term symptoms and associated diseases only recently recognized as consequences of infection. Along these lines, recent studies document a significant association between HIV infection and osteoporosis. This article reviews clinical data, considers possible causal factors and presents an opinion on the clinical implications of HIV-associated metabolic bone disease. Recent findings Clinical studies demonstrate that HIV infection is associated with reduced bone mineral density. Various factors contribute to this phenomenon. The infection itself clearly reduces bone mineral quality both directly and indirectly. Furthermore, the medications used to treat HIV show a spectrum of effects on bone. As opposed to classic osteoporosis, HIV-associated bone mineral density reduction appears to have a more pronounced effect in males. Interestingly, the protective effect of female sex appears to be entirely reversed at menopause. There remain few data regarding the incidence of fragility fractures among HIV+ patients. Summary HIV infection is associated with reduced bone mineral density, the cause of which is likely multifactorial. Clinically, HIV must be recognized as an independent risk factor of osteoporosis and osteopenia.