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Bone, fracture and frailty

Hoy, Jennifer

Current Opinion in HIV and AIDS: July 2011 - Volume 6 - Issue 4 - p 309–314
doi: 10.1097/COH.0b013e3283478741
Cohort analysis of clinical and treatment outcomes: Edited by Carolyn Williams, Matthew Law and François Dabis

Purpose of review This review details recent findings from cohort studies that inform the prevalence, incidence and effects of antiretroviral therapy (ART) and HIV infection on low bone mineral density (BMD), osteoporosis and fractures in different populations of HIV-infected individuals. Although ART has been spectacularly effective in prevention of disease progression and improvement in survival, the effects of ART on bone health require more research.

Recent findings Both HIV infection and ART are associated with significant bone loss in HIV-infected individuals. The clinical consequence of low BMD, fragility fractures are more common in older HIV patients, but the significance of low BMD remains unclear in younger individuals. Vitamin D deficiency is common, but the prevalence is no different to the general population, and no effect on BMD has been noted in cross-sectional studies. Frailty occurs at a prevalence of about 10% and is related to impaired immunity.

Summary This review examines the contributions from recent cohort studies to the understanding of the pathogenesis of bone loss in HIV, and the complex and poorly understood relationship between the effects of HIV and that of ART on bone loss.

Infectious Diseases Unit, The Alfred Hospital, and Monash University, Melbourne, Australia

Correspondence to Jennifer Hoy, Director of HIV Medicine, Infectious Diseases Unit, The Alfred Hospital, Melbourne, Australia Tel: +61 3 9076 6900; e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.