Recommendations for management of bone health in people living with HIV

The Osteo Renal Exchange program (OREP)

An international panel of 34 HIV specialists from 16 countries has published guidance on the screening, diagnosis, and monitoring of bone disease in people living with HIV.

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 men aged 40–49 years and premenopausal women aged ≥40 years. DXA should be performed in men aged ≥50 years, postmenopausal women, people with a history of fragility fracture, those receiving chronic glucocorticoid treatment, and 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; 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.
• Antiosteoporosis treatment should be used when needed.

Reference

Brown TT et al. Recommendations for Evaluation and Management of Bone Disease in HIV. CID 60(8):1242–1251. (15 April 2015).
https://doi.org/10.1093/cid/civ010