Bone loss in patients with HIV infection

Joint Bone Spine. 2009 Dec;76(6):637-41. doi: 10.1016/j.jbspin.2009.10.003.


The prognosis of HIV infection has been considerably improved by the introduction of antiretroviral drugs. However, the longer survival times are associated with the emergence of new complications including decreased bone mineral density (BMD) values and/or bone insufficiency fractures. A meta-analysis of studies published between 1966 and 2005 showed bone absorptiometry results indicating osteoporosis in 15% of HIV patients and osteopenia in 52%. Longitudinal studies found no evidence that antiretroviral drug therapy contributed to the occurrence of bone loss. Available data indicate uncoupling with increases in bone resorption markers and decreases in bone formation markers. In addition to conventional risk factors for osteoporotic fractures, factors in HIV-infected patients may include malnutrition (wasting syndrome), hypogonadism, disorders in calcium and phosphate metabolism, and HIV infection per se. In patients with established bone insufficiency, bisphosphonate therapy should be considered. Alendronate in combination with vitamin D and calcium supplementation has been found effective in improving BMD values.

Publication types

  • Review

MeSH terms

  • Alendronate / therapeutic use
  • Anti-Retroviral Agents / therapeutic use
  • Bone Density / drug effects
  • Bone Density Conservation Agents / therapeutic use
  • Bone Resorption / drug therapy
  • Bone Resorption / metabolism
  • Calcium / administration & dosage
  • Drug Therapy, Combination
  • Fractures, Stress / complications
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • HIV Wasting Syndrome / drug therapy
  • HIV Wasting Syndrome / metabolism
  • Humans
  • Meta-Analysis as Topic
  • Osteoporosis / complications*
  • Osteoporosis / etiology
  • Osteoporosis / metabolism
  • Vitamin D / administration & dosage


  • Anti-Retroviral Agents
  • Bone Density Conservation Agents
  • Vitamin D
  • Calcium
  • Alendronate