New guidelines published in the journal Clinical Infectious diseases, recommend screening for bone fracture risk in all patients over the age of 40, who have HIV. This is in addition to all post menopausal women and men over the age of 50. They recommend that these patients undergo DEXA screening( a type of X-ray) to asses their bone mineral density.

People infected with HIV have a higher rate of low bone mineral density (osteopenia) and fractures than the average population. In some studies the rates of fractures of the spine, hip and wrist was approximately 60% higher than in non HIV infected persons. This is clearly a huge and important difference in risk and we need to be more vigilant in this population of patients.

The jury is still out as to why their is this increased risk, but we know that bone mineral density declines by 2-6% in the first few years after starting HAART ( Highly active anti-retroviral therapy) for HIV. In particular there is evidence that treatment with tenofovir and boosted protease inhibitors cause greater bone loss than other drugs for HIV. It is suggested that in this patient population clinicians should consider switching regimens, if the patient is deemed to be at higher risk of low bone mineral density.

We also know that people with HIV tend to have more risk factors such as smoking, higher alcohol consumption, low body weihgt and poor nutrition so these could all be contributing factors. As more people with HIV are now living into old age, the risk of osteoporosis also increases, so there is a real unmet need to screen for this.

The new recommendations are that people at risk and over 40 years of age with HIV, should undergo DEXA screening.  If DEXA screening is not readily available there is a scoring system called FRAX, that could be used to see who are in the higher risk for fractures and prioritise those patients  for DEXA scans.

There are many ways to improve bone mineral density such as improving diet and doing more regular exercise, calcium replacement therapy and correcting vitamin D levels , stopping smoking and by reducing alcohol consumption.

If you have HIV and you are over 40 years of age, I would recommend that you ask your doctor if you could be screened for your bone fracture risk and try modify your lifestyle to reduce your risk.