Prevention of Bone Loss and Management of Fracture Risk in HIV-Infected Individuals: Case Studies and Recommendations for Different Patient Subgroups

Abstract

Increased life-expectancy and the need for long-term antiretroviral therapy have brought new challenges to the clinical management of HIV-infected individuals. While the prevalence of osteoporosis and fractures is probably increased in HIV-infected patients, optimal strategies for risk assessment and treatment in this relatively young population are yet to be defined. Prevention of bone loss is likely to become an important component of HIV care as the HIV-infected patient population grows older. In this article, we present an overview of the literature on bone loss in individuals with HIV and discuss the practical application of the European AIDS Clinical Society (EACS) guidelines to a range of clinical case scenarios.

Keywords::

• aging
• antiretroviral therapy
• BMD
• bone mineral density
• cART
• dual-energy x-ray absorptiometry
• DXA
• HIV
• osteoporosis

Financial & competing interests disclosure

In the last 5 years, FA Post has received research funding and/or honoraria for speaking engagements or consultancy from GlaxoSmithKline, ViiV Healthcare, Janssen (Tibotec), Bristol-Myers Squibb, Merck Sharp & Dohme and Gilead Sciences; EV McCloskey has received honoraria or grant funding from AstraZeneca, Amgen, Lilly, GlaxoSmithKline, Hologic, Novartis, Pfizer, Roche and ViiV Healthcare; JE Compston has received honoraria for advisory work from ViiV Healthcare, GlaxoSmithKline, Gilead Sciences, Merck Sharp & Dohme and Novartis, and for speaking from Gilead Sciences and Merck Sharp & Dohme; CA Bowman has received honoraria for speaking or consultancy, sponsorship for conference attendance and funding for HIV outreach projects from GlaxoSmithKline, ViiV Healthcare, Bristol-Myers Squibb, Boehringer Ingelheim and Gilead Sciences; PE Hay has received payment for consultancy, speaker honoraria, sponsorship for conference attendance and funding for his unit for clinical trials from Abbott, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Pfizer, Roche, Janssen (Tibotec) and ViiV Healthcare; PWG Mallon has received support in the form of honoraria, research grants, travel expenses, lecture sponsorships or advisory board honoraria from Bristol-Myers Squibb, Abbott, Merck Sharp & Dohme, Pfizer, Gilead Sciences, GlaxoSmithKline, Pfizer, ViiV Healthcare and Roche; BS Peters has received honoraria for speaking or consultancy from ViiV Healthcare, Bristol-Myers Squibb, Abbott and Gilead Sciences; A Samarawickrama has received travel bursaries and scholarships from Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, Merck Sharp & Dohme, Janssen (Tibotec) and ViiV Healthcare, and honoraria for advisory work for ViiV Healthcare; and G Tudor-Williams has received consultancy fees from ViiV Healthcare. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Writing assistance was utilized in the production of this manuscript. Medical writing assistance was provided by Esther Race of ArticulateScience and was funded by ViiV Healthcare.

Notes

BMD: Bone mineral density; DXA: Dual-energy x-ray absorptiometry; PTH: Parathyroid hormone.

ALP: Alkaline phosphatase; DXA: Dual-energy x-ray absorptiometry; HCV: Hepatitis C virus; PTH: Parathyroid hormone.

ALP: Alkaline phosphatase; DXA: Dual-energy x-ray absorptiometry.

DXA: Dual-energy x-ray absorptiometry; HBV: Hepatitis B virus; HCV: Hepatitis C virus.

Additional information

Funding

In the last 5 years, FA Post has received research funding and/or honoraria for speaking engagements or consultancy from GlaxoSmithKline, ViiV Healthcare, Janssen (Tibotec), Bristol-Myers Squibb, Merck Sharp & Dohme and Gilead Sciences; EV McCloskey has received honoraria or grant funding from AstraZeneca, Amgen, Lilly, GlaxoSmithKline, Hologic, Novartis, Pfizer, Roche and ViiV Healthcare; JE Compston has received honoraria for advisory work from ViiV Healthcare, GlaxoSmithKline, Gilead Sciences, Merck Sharp & Dohme and Novartis, and for speaking from Gilead Sciences and Merck Sharp & Dohme; CA Bowman has received honoraria for speaking or consultancy, sponsorship for conference attendance and funding for HIV outreach projects from GlaxoSmithKline, ViiV Healthcare, Bristol-Myers Squibb, Boehringer Ingelheim and Gilead Sciences; PE Hay has received payment for consultancy, speaker honoraria, sponsorship for conference attendance and funding for his unit for clinical trials from Abbott, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Pfizer, Roche, Janssen (Tibotec) and ViiV Healthcare; PWG Mallon has received support in the form of honoraria, research grants, travel expenses, lecture sponsorships or advisory board honoraria from Bristol-Myers Squibb, Abbott, Merck Sharp & Dohme, Pfizer, Gilead Sciences, GlaxoSmithKline, Pfizer, ViiV Healthcare and Roche; BS Peters has received honoraria for speaking or consultancy from ViiV Healthcare, Bristol-Myers Squibb, Abbott and Gilead Sciences; A Samarawickrama has received travel bursaries and scholarships from Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, Merck Sharp & Dohme, Janssen (Tibotec) and ViiV Healthcare, and honoraria for advisory work for ViiV Healthcare; and G Tudor-Williams has received consultancy fees from ViiV Healthcare. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Writing assistance was utilized in the production of this manuscript. Medical writing assistance was provided by Esther Race of ArticulateScience and was funded by ViiV Healthcare.