HIV Management Guide for Clinical Care and ARV Guidelines

HIV Management Guide for Clinical Care and ARV Guidelines

Bone disease in patients with HIV infection

Bone disease in patients with HIV infection

David Sowden1. Thomas Hadwen2 Department of Infectious Diseases, Sunshine Coast University Hospital, Queensland. Department of Endocrinology, Sunshine Coast University Hospital, Queensland.  Last reviewed: November 2019  Introduction  Age-relates co-morbidities, such as osteoporosis, become more important as the HIV population ages. Added to aging, associated co-morbidities, anti-retroviral therapy and the effect of HIV itself contribute to bone …

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Osteoporosis

Definitions Osteoporosis is characterised by low bone mineral density (BMD), and changes in bone architecture, leading to decreased bone strength and an increased  fracture risk.1 The World Health Organisation (WHO) has defined osteoporosis on the basis of the T-score.2 Osteoporosis is defined as a T-score of -2.5 or below, osteopaenia as a T-score of between -1.0 and …

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Screening tests for osteoporosis

It is recommended to assess the risk of fragility fracture and low BMD in all patients with HIV infection.9 Important risk factors for fracture include: Previous history of fragility fracture Glucocorticoid therapy for more than 3 months High risk of falls Those with these risk factors should be assessed with dual-energy X-ray absorptiometry (DXA).  In …

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Management of osteoporosis

Anti-retroviral therapy  In those with low BMD or osteoporosis, tenofovir disoproxil fumarate should be avoided.35 A new formulation of tenofovir, tenofovir alafenamide (TAF) is associated with less bone and renal toxicity compared to TDF. In those at high risk of bone toxicity, TDF therapy should be changed to TAF.12,13,35  Studies examining switching from regimens containing …

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Osteomalacia

Osteomalacia is characterised by impaired mineralisation of bone, usually caused by vitamin D deficiency but can also be secondary to several other rarer conditions.  It is associated with low BMD, as measured by DXA, and fractures.6 Phosphate wasting caused by the use of TDF may be associated with osteomalacia. The clinical presentation is characterised by …

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Osteonecrosis

Also known as avascular necrosis of bone (AVN), this condition results from deficient blood supply to bone resulting in bone death and has been long described in HIV-infected persons.27 Subsequent studies showed that the risk of this condition is increased 100-fold in the HIV-infected population compared to the general population.26 MRI studies have shown that …

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Bone Disease in other groups

HIV-negative persons receiving Pre-Exposure Prophylaxis (PrEP)  PrEP is recommended in HIV-negative persons who are at high-risk for HIV infection.13 The recommended regimen for PrEP involves a fixed-dose combination of oral emtricitabine/tenofovir disoproxil fumarate (FTC/TDF). Given the association of TDF with bone loss, concern exists about bone toxicity in those receiving PrEP.  A sub-study from an …

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References

The Royal Australian College of General Practitioners and Osteoporosis Australia. Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age, 2nd edn.  East Melbourne, Vic: RACGP,2017. World Health Organisation. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. Technical Report Series, …

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