Diagnosis, prevention, and treatment of bone fragility in people living with HIV: a position statement from the Swiss Association against Osteoporosis.

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Serval ID
serval:BIB_8281472D9E9E
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Diagnosis, prevention, and treatment of bone fragility in people living with HIV: a position statement from the Swiss Association against Osteoporosis.
Journal
Osteoporosis international
Author(s)
Biver E., Calmy A., Aubry-Rozier B., Birkhäuser M., Bischoff-Ferrari H.A., Ferrari S., Frey D., Kressig R.W., Lamy O., Lippuner K., Suhm N., Meier C.
ISSN
1433-2965 (Electronic)
ISSN-L
0937-941X
Publication state
Published
Issued date
05/2019
Peer-reviewed
Oui
Volume
30
Number
5
Pages
1125-1135
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Life expectancy of people living with HIV (PLWH) is reaching similar length as in the general population. Accordingly, age-related comorbidities, including osteoporosis, are increasing. Fracture risk is higher and increases approximately 10 years earlier in PLWH. Classical risk factors of bone fragility are highly prevalent in PLWH but factors specific for HIV infection itself and the type of antiretroviral therapy (ART) (triple combination antiretroviral therapy) regimen (especially tenofovir and protease inhibitors) also contribute to bone loss. The majority of bone loss occurs during virus activity and at initiation of ART (immune reconstitution) and is associated with an increase of bone resorption (upregulation RANKL). Recent data indicate that calcium and vitamin D supplements as ART initiation lower BMD loss. The reduction of tenofovir plasma concentrations with tenofovir alafenamide attenuates BMD loss but it remains unknown whether it will contribute to reduce fracture risk. Hence, special considerations for the management of bone fragility in PLWH are warranted. Based on the current state of epidemiology and pathophysiology of osteoporosis in PLWH, we provide the consensus of the Swiss Association against Osteoporosis on best practice for diagnosis, prevention, and management of osteoporosis in this population. Periodic assessment of fracture risk is indicated in all HIV patients and general preventive measures should be implemented. All postmenopausal women, men above 50 years of age, and patients with other clinical risk for fragility fractures qualify for BMD measurement. An algorithm clarifies when treatment with bisphosphonates and review of ART regimen in favour of more bone-friendly options are indicated.
Keywords
Bone fragility, Diagnosis, HIV, Management, Osteoporosis, Prevention
Pubmed
Web of science
Create date
28/01/2019 10:11
Last modification date
03/02/2020 16:13
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