HIV and fracture: Risk, assessment and intervention.

Autor: McGee DM; Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Republic of Ireland., Cotter AG; Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Republic of Ireland.; UCD Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Republic of Ireland.
Jazyk: angličtina
Zdroj: HIV medicine [HIV Med] 2024 May; Vol. 25 (5), pp. 511-528. Date of Electronic Publication: 2023 Dec 12.
DOI: 10.1111/hiv.13596
Abstrakt: Objectives: With management of comorbidity in people living with HIV (PLWH) a key component of clinical care, early loss of bone integrity and clinical fracture are recognized as important issues. This review aims to describe the epidemiology of fracture in PLWH, as well as summarizing the relative balance of factors that contribute to fracture. We also aim to describe fracture risk assessment and interventional strategies to modify the risk of fracture in this population.
Results: Data from recent meta-analyses show that PLWH have significantly more fractures than the general population, with men and injecting drug users at higher risk. Modifiable factors that contribute to fracture risk in this cohort include body mass index (BMI), drug use, concurrent medications, frailty, and hepatitis C virus infection. Relating to antiretroviral therapy, current or ever tenofovir exposure has been identified as predictive of fracture but not cumulative use, and a potentially modest protective effect of efavirenz has been observed. Fracture Risk Assessment Tool scores underestimate fracture risk in PLWH with improved accuracy when HIV is considered a cause of secondary osteoporosis and bone mineral density (BMD) included.
Conclusion: Early consideration of risk, prompting evaluation of modifiable risk factors, frailty and falls risk with bone density imaging and prompt intervention may avert fracture in PLWH. Guidance on screening and lifestyle modification is available in international guidelines. Bisphosphonates are safe and effective in PLWH, with limited data for other agents.
(© 2023 British HIV Association.)
Databáze: MEDLINE
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