Sudipa Sarkar, MD, MSCI, Todd T. Brown, M.D., Ph.D.


  • Osteoporosis in people with HIV (PWH) is 3-4 times more common than in the general population.
  • Increased prevalence may be due in part to high prevalence of risk factors, including low body weight, hypogonadism, smoking, alcohol use, low vitamin D levels, and steroid use.
  • The role of ART is unclear. ART initiation is associated with 2-3% loss in bone mineral density (BMD) in the first 6 months in multiple studies. It is unclear if this is due to medication effect or a by-product of viral suppression and/or immune reconstitution. Longitudinal studies of treated PWH generally show stable BMD over time.
  • Bone loss with initiation of TDF-FTC is more pronounced than with ABC-3TC.[7]
  • BMD explains approximately 50% of fracture risk in general population, perhaps less in PWH. Bone quality is also important but is difficult to assess.
  • Fracture risk in PWH not adequately assessed to date.[6]

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Last updated: January 13, 2021