HIV-ASSOCIATED CO-MORBIDITIES: Edited by Morris Schambelan and Todd T. BrownWhat's new in bone disease and fractures in HIV?Alvarez-Barco, Elenaa; Mallon, Patrick W.G.a,bAuthor Information aCentre for Experimental Pathogen Host Research, School of Medicine, University College Dublin bSt Vincent's University Hospital, Elm Park, Dublin, Ireland Correspondence to Patrick W.G. Mallon, Centre for Experimental Pathogen Host Research, University College Dublin, Belfield, Dublin, Ireland. E-mail: [email protected] Current Opinion in HIV and AIDS: May 2021 - Volume 16 - Issue 3 - p 186-191 doi: 10.1097/COH.0000000000000682 Buy Metrics Abstract Purpose of review People living with HIV (PWH) are at greater risk of low bone mineral density (BMD) and fractures compared to the general population. This narrative review summarises recent literature in the field, including the relative contribution of antiretroviral therapy and frailty to low BMD and fractures in PWH. Recent findings The body of evidence indicating less impact on BMD from the use of tenofovir alafenamide compared to tenofovir disoproxil fumarate continues to grow, although this has not yet translated into data supporting a reduction in fracture incidence. Frailty, common in PWH, is associated with both fractures and alterations in renal-bone metabolism, but is an area that is understudied in relation to interventions to reduce fracture risk in PWH. Summary Although a maturing field, research into interventions to reduce fracture incidence in PWH is lacking in both quantity and scope. Development of core outcome datasets for clinical trials along with trials focused on reducing or reversing frailty are required to guide improvements overall bone health outcomes in PWH. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.