Bone disease in HIV infection: A practical review and recommendations for HIV care providers

Grace A. McComsey, Pablo Tebas, Elizabeth Shane, Michael T. Yin, E. Turner Overton, Jeannie S. Huang, Grace M. Aldrovandi, Sandra W. Cardoso, Jorge L. Santana, Todd T. Brown

Research output: Contribution to journalReview articlepeer-review


Low bone mineral density (BMD) is prevalent in human immunodeficiency virus (HIV)-infected subjects. Initiation of antiretroviral therapy is associated with a 2%-6% decrease in BMD over the first 2 years, a decrease that is similar in magnitude to that sustained during the first 2 years of menopause. Recent studies have also described increased fracture rates in the HIV-infected population. The causes of low BMD in individuals with HIV infection appear to be multifactorial and likely represent a complex interaction between HIV infection, traditional osteoporosis risk factors, and antiretroviral-related factors. In this review, we make the point that HIV infection should be considered as a risk factor for bone disease. We recommend screening patients with fragility fractures, all HIV-infected post-menopausal women, and all HIV-infected men ≥50 years of age. We also discuss the importance of considering secondary causes of osteoporosis. Finally, we discuss treatment of the more severe cases of bone disease, while outlining the caveats and gaps in our knowledge.

Original languageEnglish (US)
Pages (from-to)937-946
Number of pages10
JournalClinical Infectious Diseases
Issue number8
StatePublished - Oct 15 2010

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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