Elena Alvarez1, Waldo H Belloso, Mark A Boyd, Ahmet Ç Inkaya, Evelyn Hsieh, Andrew Kambugu, Greg Kaminski, Esteban Martinez, Hans-Jürgen Stellbrink, Sharon Walmsley, Todd T Brown, Patrick W G Mallon. 1. aHIV Molecular Research Group, School of Medicine, University College Dublin, Dublin, Ireland bInfectious Diseases and Clinical Pharmacology Sections, Internal Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina cThe Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia dSchool of Medicine, Hacettepe University, Ankara, Turkey eDepartment of Infectious Diseases at Peking Union Medical College Hospital, Beijing, China fInfectious Diseases Institute (IDI) HIV outpatient clinic at Mulago Hospital Complex, Makerere University College of Health Sciences, Kampala, Uganda gMoscow Regional AIDS Centre, Moscow, Russia hInfectious Diseases Unit Hospital Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain iICH Study Center, Hamburg, Germany jToronto General Research Institute (TGRI), University Health Network (NHN), Toronto General Hospital, Toronto, Canada kDivision of Endocrinology, Diabetes & Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA lMater Misericordiae University Hospital, Department of Infectious Diseases, Dublin, Ireland.
Abstract
PURPOSE OF REVIEW: This review provides international insights into the real-world clinical approach to screening for bone mineral density (BMD) and osteoporosis in people living with HIV (PLWH) using opinions from HIV physicians from key regions around the world. RECENT FINDINGS: Although a significant proportion of PLWH are aged over 50, the relative importance of low BMD to clinical care differs significantly between countries and regions, based on factors such as the population at risk, access to adequate screening resources, and physicians' knowledge. Generally, management of osteoporosis in PLWH follows similar principals as for the general population, with risk factors for fracture combined with measurement of BMD by dual energy X-ray absorptiometry in algorithms such as Fracture Risk Assessment Tool, designed to provide an overall risk estimation. Although in most regions age is considered among the most important factors contributing to low BMD and fractures, considerable country and region-specific factors become apparent, such as malnutrition, inactivity and impact of comorbidities, substance abuse, and increasing use of tenofovir disoproxil fumarate. SUMMARY: These opinions highlight the diversity that still exists in the approach to the long-term management of PLWH and highlight challenges facing development of consensus guidelines that can be effectively implemented worldwide.
PURPOSE OF REVIEW: This review provides international insights into the real-world clinical approach to screening for bone mineral density (BMD) and osteoporosis in people living with HIV (PLWH) using opinions from HIV physicians from key regions around the world. RECENT FINDINGS: Although a significant proportion of PLWH are aged over 50, the relative importance of low BMD to clinical care differs significantly between countries and regions, based on factors such as the population at risk, access to adequate screening resources, and physicians' knowledge. Generally, management of osteoporosis in PLWH follows similar principals as for the general population, with risk factors for fracture combined with measurement of BMD by dual energy X-ray absorptiometry in algorithms such as Fracture Risk Assessment Tool, designed to provide an overall risk estimation. Although in most regions age is considered among the most important factors contributing to low BMD and fractures, considerable country and region-specific factors become apparent, such as malnutrition, inactivity and impact of comorbidities, substance abuse, and increasing use of tenofovir disoproxil fumarate. SUMMARY: These opinions highlight the diversity that still exists in the approach to the long-term management of PLWH and highlight challenges facing development of consensus guidelines that can be effectively implemented worldwide.
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