is reported as a common comorbidity in patients living with HIV
(PLHIV). The aim of this systematic review and meta-analysis is to assess the evidence on fracture
risk in PLHIV, bone mineral density
(BMD) in PLHIV compared with controls, longitudinal changes in BMD in PLHIV, and effect of antiosteoporosis treatment in PLHIV.
A systematic literature search was conducted using the databases Medline at PubMed and EMBASE using the search terms: “HIV
” and “fracture
” or “bone turnover,” or “bone mineral density
.” Eligibility criteria followed the aim of the study and include randomized controlled trials and observational studies. Two reviewers extracted the data independently. Meta-analysis was performed using random-effects model assessing fracture
risk, BMD compared with controls, and changes in BMD.
One hundred forty-two of 2397 papers identified were included in the systematic review, and subsequently, 84 were included in the meta-analysis. The risks of a fragility fracture
[1.51, 95% confidence interval (CI): 1.41 to 1.63] and hip fracture
(4.05, 95% CI: 2.99 to 5.49) were increased. PLHIV have lower BMD at the hip (z-score −0.31, 95% CI: −0.46 to −0.27) and lumbar spine (z-score −0.36, 95% CI: −0.39 to −0.15) compared with controls. The reduced BMD did not fully explain the increased fracture
risk in PLHIV.
Current management of osteoporosis
in PLHIV follows general osteoporosis
guidelines; however, the increased fracture
risk is not fully explained by lower BMD, and thus, antiosteoporosis intervention may be beneficial at a higher BMD in PLHIV.