Recommendations for evaluation and management of bone disease in HIV

Todd T. Brown, Jennifer Hoy, Marco Borderi, Giovanni Guaraldi, Boris Renjifo, Fabio Vescini, Michael T. Yin, William G. Powderly

Research output: Contribution to journalArticle

Abstract

Thirty-four human immunodeficiency virus (HIV) specialists from 16 countries contributed to this project, whose primary aim was to provide guidance on the screening, diagnosis, and monitoring of bone disease in HIV-infected patients. Four clinically important questions in bone disease management were identified, and recommendations, based on literature review and expert opinion, were agreed upon. Risk of fragility fracture should be assessed primarily using the Fracture Risk Assessment Tool (FRAX), without dual-energy X-ray absorptiometry (DXA), in all HIV-infected men aged 40-49 years and HIV-infected premenopausal women aged ≥ 40 years. DXA should be performed in men aged ≥ 50 years, postmenopausal women, patients with a history of fragility fracture, patients receiving chronic glucocorticoid treatment, and patients at high risk of falls. In resource-limited settings, FRAX without bone mineral density can be substituted for DXA. Guidelines for antiretroviral therapy should be followed; adjustment should avoid tenofovir disoproxil fumarate or boosted protease inhibitors in at-risk patients. Dietary and lifestyle management strategies for high-risk patients should be employed and antiosteoporosis treatment initiated.

Original languageEnglish (US)
Pages (from-to)1242-1251
Number of pages10
JournalClinical Infectious Diseases
Volume60
Issue number8
DOIs
StatePublished - Apr 15 2015

Keywords

  • bone disease
  • fragility fracture
  • human immunodeficiency virus
  • osteoporosis

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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    Brown, T. T., Hoy, J., Borderi, M., Guaraldi, G., Renjifo, B., Vescini, F., Yin, M. T., & Powderly, W. G. (2015). Recommendations for evaluation and management of bone disease in HIV. Clinical Infectious Diseases, 60(8), 1242-1251. https://doi.org/10.1093/cid/civ010