Purpose of review
This review details recent findings that inform the prevalence and incidence of fractures
in people living with HIV
(PLWH) and examines the effects of HIV
infection and antiretroviral therapy
(ART), as well as demographics and traditional risk factors on fractures
. As antiretroviral guidelines have recently changed to recommend the introduction of ART at diagnosis of HIV
infection, the long-term effects of ART on bone health and fracture risk need to be better understood.
It is apparent that both the effects of HIV
infection alone and initiation of ART are associated with significant bone loss in individuals with HIV
infection, resulting in osteopenia and osteoporosis. The clinical consequence of low bone mineral density is a greater risk of fragility fractures
that are more common in older HIV
patients, and those on ART. Frailty
occurs at a prevalence of about 10% (about twice that of the general population), and the increased propensity of falls results in greater fracture prevalence, morbidity and mortality.
This review examines data from recent cohort studies and clinical trials to inform a better understanding of the complex relationship between the effects of HIV
infection, ART and demographics on fractures