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British Medical Bulletin Advance Access published online on October 29, 2009
British Medical Bulletin, doi:10.1093/bmb/ldp037
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© The Author 2009. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Bone health in HIV infection

Emily Pollock{dagger}, Angelos-Emmanouil Klotsas{ddagger}, Juliet Compston§ and Effrossyni Gkrania-Klotsas,*

{dagger} Clinical School of Medicine, University of Cambridge, Cambridge, UK
{ddagger} Department of Endocrinology and Diabetes, Luton and Dunstable Hospital, Luton, UK
§ Clinical School of Medicine and Addenbrooke's Hospital, Box 157, Cambridge, UK
Department of Infectious Diseases, Addenbrooke's Hospital, Box 153, Cambridge CB2 2QQ, UK

* Correspondence to: Effrossyni Gkrania-Klotsas, Department of Infectious Diseases, Addenbrooke's Hospital, Box 153, Hills Road, Cambridge CB2 2QQ, UK. E-mail: eg318{at}cam.ac.uk

Introduction: Osteoporosis is among the chronic problems emerging as the human immunodeficiency virus (HIV)-positive population ages.

Sources of data: We reviewed the English language bibliography using Pubmed 2.0, Web of Science and Embase for relevant abstracts and articles.

Areas of agreement: The prevalence of low bone mineral density (BMD) and fracture is increased in the HIV-positive population.

Areas of controversy: The pathogenesis is multifactorial; there is some evidence that HIV infection is an independent risk factor and that highly active antiretroviral therapy has adverse skeletal effects.

Growing points: Physicians should routinely review the bone health of all HIV patients.

Areas timely for developing research: More studies of the mechanisms of bone loss, the skeletal effects of antiretroviral therapy and the therapeutic outcome of bone-protective therapy in HIV-positive individuals are needed.

Keywords: HIV • AIDS • osteoporosis • fracture • vitamin D • bisphosphonates • bone mineral density • antiretroviral

Accepted for publication September 21, 2009.


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