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Clin Infect Dis. 2015 Apr 15;60(8):1242-51. doi: 10.1093/cid/civ010. Epub 2015 Jan 21.

Recommendations for evaluation and management of bone disease in HIV.

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Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Australia.
Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna.
Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy.
Global Medical Affairs Virology, Global Pharmaceutical Research and Development, AbbVie, North Chicago, Illinois.
Endocrinology and Metabolism Unit, University Hospital "Santa Maria della Misericordia," Udine, Italy.
Department of Medicine, Columbia University Medical Center, New York, New York.
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri.


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.


bone disease; fragility fracture; human immunodeficiency virus; osteoporosis

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