- 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.
- 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.
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Last updated: January 13, 2021
Sarkar, Sudipa, and Todd T Brown. "Osteoporosis." Johns Hopkins HIV Guide, 2021. Johns Hopkins Guides, www.hopkinsguides.com/hopkins/view/Johns_Hopkins_HIV_Guide/545154/all/Osteoporosis.
Sarkar S, Brown TT. Osteoporosis. Johns Hopkins HIV Guide. 2021. https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_HIV_Guide/545154/all/Osteoporosis. Accessed June 9, 2023.
Sarkar, S., & Brown, T. T. (2021). Osteoporosis. In Johns Hopkins HIV Guide https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_HIV_Guide/545154/all/Osteoporosis
Sarkar S, Brown TT. Osteoporosis [Internet]. In: Johns Hopkins HIV Guide. ; 2021. [cited 2023 June 09]. Available from: https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_HIV_Guide/545154/all/Osteoporosis.
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