Recommendations for management of bone disease in HIV
Simon Collins. HIV i-Base
A new set of international guidelines for management of bone disease in HIV positive adults was published on 21 January 2015 as an invited article in CID.
The recommendations focus on four clinically important aspects of care.
- HIV postive men aged 40–49 years and HIV positive premenopausal women aged 40 years and above should be primarily assessed for risk of fragility fracture using FRAX (without DEXA scans).
- DEXA scans should be used to predict risk: in (a) men who are 50 or older: (b) postmenopausal women; (c) those with a history of fragility fracture; (d) those receiving chronic glucocorticoid treatment; and (e) those at high risk of falls.
- In resource-limited settings, FRAX without bone mineral density can be substituted for DXA.
- Guidelines for ART should be followed but adjustment should avoid tenofovir disoproxil fumarate or boosted protease inhibitors in at-risk patients. Patients at high-risk of bone disease should have appropriate dietary and lifestyle management strategies including anti-osteoporosis treatment.
These are consensus guidelines based on a “comprehensive literature review” and expert opinion.
A level of evidence and grade of recommendation (GOR) was assigned to each statement, in accordance with the Oxford Centre for Evidence-Based Medicine 2009 criteria.
Funding for the guidelines and for a similar document looking at renal monitoring was provided by AbbVie, and the results were presented at an industry satellite meeting at the IAS conference in Melbourne in 2014. 
- Brown TT et al. Recommendations for Evaluation and Management of Bone Disease in HIV. Invited article: Clin Infect Dis. (2015). First published online: January 21, 2015. doi: 10.1093/cid/civ010. Free open access.
- Bone and Renal Comorbidities in HIV: The Osteo-Renal Exchange Program. 20th International AIDS Conference, 20-25 July 2014. Industry satellite meeting MOSA01.