Drugs & Aging

, Volume 32, Issue 7, pp 549–558 | Cite as

Bone Disease in HIV: Recommendations for Screening and Management in the Older Patient

  • Jennifer HoyEmail author
Therapy in Practice


Availability of potent antiretroviral therapy (ART) has resulted in markedly improved survival for people with human immunodeficiency virus (HIV) infection, as well as an aging HIV population. Increasing morbidity from age-related conditions has resulted in the need to understand the complex roles HIV and its treatment play in the pathogenesis of these conditions. Bone disease and fragility fractures are conditions that occur more frequently in HIV. It is therefore recommended that risk assessment for fragility fracture using the Fracture Risk Assessment Tool (FRAX®) algorithm, and low bone mass by dual energy X-ray absorptiometry (DXA) scan, be performed in all patients with HIV infection over the age of 50 years and in those with a history of fragility fracture, and should be repeated every 2–3 years. Because many HIV experts believe that HIV infection and its treatment is a secondary cause of osteoporosis, it should be included as such in the FRAX® assessment tool. Management of osteoporosis in HIV infection should follow the same guidelines as that in the general population. Attention to lifestyle factors, including vitamin D replacement, should be emphasized. Whether cessation of tenofovir- or protease inhibitor-based ART regimens should be considered prior to bisphosphonate treatment is currently unknown and should only occur in patients with active alternative ART regimens. The use of bisphosphonates has been shown to be safe and effective in HIV patients, and while there is limited data on second-line osteoporosis regimens, there is no reason to suggest they would not be effective in people with HIV.


Bone Mineral Density Human Immunodeficiency Virus Fracture Risk Human Immunodeficiency Virus Infection Tenofovir 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest & Funding

Jennifer Hoy’s institution (The Alfred Hospital) has received funding for her involvement in advisory boards for Gilead Sciences, Merck Sharp and Dohme, and ViiV Healthcare. No funding was received for the preparation of this invited manuscript.


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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Department of Infectious DiseasesThe Alfred Hospital and Monash UniversityMelbourneAustralia

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