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- Osteoporosis in HIV+ pts 3-4x more common than in general population.
- Increased prevalence may be due in part to high prevalence of risk factors, including low body weight, hypogonadism, smoking, alcohol use, steroid use.
- Role of ART unclear. ART initiation associated with 2-3% loss in bone mineral density (BMD) in first 6 mos in multiple studies. Unclear if due to medication effect or by-product of viral suppression and/or immune reconstitution. Longitudinal studies of treated HIV+ pts generally show stable BMD over time.
- Specific ARVs not clearly implicated in pathogenesis, although bone loss with TDF slightly more pronounced than with d4T.
- BMD explains approximately 50% of fracture risk in general population,perhaps less in HIV+ pts. Bone quality also important but difficult to assess.
- Fracture risk in HIV+ pts not adequately assessed to date