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

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Abstract

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.

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Acknowledgments

The authors thank Dr. Isabel Hartmann for manuscript editing.

Author information

Authors and Affiliations

  1. Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland

    E. Biver & S. Ferrari

  2. HIV/Aids Unit, Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland

    A. Calmy

  3. Center of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland

    B. Aubry-Rozier & O. Lamy

  4. Gynecological Endocrinology and Reproductive Medicine, University of Berne, Basel, Switzerland

    M. Birkhäuser

  5. Department of Geriatrics and Aging Research, University of Zurich and University Hospital of Zurich, Zurich, Switzerland

    H. A. Bischoff-Ferrari

  6. Division of Rheumatology, University Hospital Zürich, Zürich, Switzerland

    D. Frey

  7. University Center for Medicine of Aging, Basel Mobility Center, University of Basel, Basel, Switzerland

    R. W. Kressig

  8. Department of Osteoporosis, University Hospital, University of Berne, Berne, Switzerland

    K. Lippuner

  9. Department of Orthopedics and Traumatology, Geriatric Fracture Center, University Hospital Basel, Basel, Switzerland

    N. Suhm

  10. Division of Endocrinology, Diabetology & Metabolism, University Hospital and University of Basel, Missionsstrasse 24, CH-4055, Basel, Switzerland

    C. Meier

Authors
  1. E. Biver
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  2. A. Calmy
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  3. B. Aubry-Rozier
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  4. M. Birkhäuser
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  5. H. A. Bischoff-Ferrari
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  6. S. Ferrari
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  7. D. Frey
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  8. R. W. Kressig
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  9. O. Lamy
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  10. K. Lippuner
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  11. N. Suhm
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  12. C. Meier
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Corresponding author

Correspondence to C. Meier.

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Conflicts of interest

Alexandra Calmy has received travel grants from Gilead and unrestricted educational grants from Gilead, ViiV, MSD, and AbbVie. Emmanuel Biver, Bérengère Aubry-Rozier, Martin Birkhäuser, Heike A. Bischoff-Ferrari, Serge Ferrari, Diana Frey, Reto W. Kressig, Olivier Lamy, Kurt Lippuner, Norbert Suhm, and Christian Meier declare that they have no conflict of interest.

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Biver, E., Calmy, A., Aubry-Rozier, B. et al. Diagnosis, prevention, and treatment of bone fragility in people living with HIV: a position statement from the Swiss Association against Osteoporosis. Osteoporos Int 30, 1125–1135 (2019). https://doi.org/10.1007/s00198-018-4794-0

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  • DOI: https://doi.org/10.1007/s00198-018-4794-0

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