Fragility Fractures in HIV-Infected Patients: Need for Better Understanding of Diagnosis and Management

Abstract

HIV infection, AIDS, and antiretroviral therapy (ART) have been associated with bone fragility fractures, although the prevalence and incidence are not well studied by researchers. In HIV and ART, osteopenia and osteoporosis are multifactorial, and health promotion or medical health maintenance should anticipate and prevent morbidity of bone fragility fractures.

Keywords

HIV antiretroviral therapy osteopenia osteoporosis pathological fractures fragility fractures

References

Carr A , Miller J , Eisman JA , Cooper DA . Osteopenia in HIV-infected men: Association with asymptomatic lactic acidemia and lower weight pre-antiretroviral therapy. AIDS 2001;15:703-709.

Tebas P , Powderly WG , Claxton S , et al. Accelerated bone mineral loss in HIV-infected patients receiving potent antiretroviral therapy. AIDS 2000;14:F63-F67.

Huang JS , Rietschel P , Hadigan CM , Rosenthal DI , Grinspoon S . Increased abdominal visceral fat is associated with reduced bone density in HIV-infected men with lipodystrophy. AIDS 2001;15:975-982.

Hoy J , Hudson J , Law M , et al. Osteopenia in a randomized multicenter study of protease inhibitor (PI) substitution in patients with the lipodystrophy syndrome and well-controlled HIV viremia. 7th Conference on Retroviruses and Opportunistic Infections. January 30-February 2, 2000. San Francisco, CA, USA. (Abstract 208). Accessed August 14, 2004 from http://www.retroconfernce.org/2000/abstracts/208.htm

Bruera D , Luna N , David DO , Bergoglio LM , Zamudio J . Decreased bone mineral density in HIV-infected patients is independent of antiretroviral therapy. AIDS 2003;17:1917-1923.

Mondy K , Tebas P . Emerging bone problems in patients infected with human immunodeficiency virus. Clin Infect Dis 2003;36(Suppl 2):S101-S105.

Lawal A , Engelson ES , Wang J , Heymsfield SB , Kotler DP . Equivalent osteopenia in HIV-infected individuals studied before and during the era of highly active antiretroviral therapy. AIDS 2001;15:278-280.

McGowan I , Cheng A , Coleman S , Johnson A , Genant H . Assessment of bone mineral density (BMD) in HIV-infected antiretroviral-therapy naive patients. 8th Conference on Retroviruses and Opportunistic Infections. February 4-February 8, 2001. Chicago, IL, USA. (Abstract 628). Accessed August 14, 2004 from http://www.retroconference.org//2001/abstracts/abstracts/abstracts/628.htm

Fessel WJ , Hurley LB . Is HIV sequestered in bone? Possible implications of virological and immunological findings in some HIV-infected patients with bone disease. AIDS 2003;17:255-257.

10.

Stephens EA , Das R , Madge S , Barter J , Johnson MA . Symptomatic osteoporosis in two young HIV-positive African women. AIDS 1999;13:2605-2606.

11.

Folefack DA , Arendt V , Schuman L . Fatigue fracture of the femoral neck in an HIV-positive female patient on antiretroviral therapy. Acta Orthop Belg 2002;68:537-541. French.

12.

Rodriguez-Recio O , Junquera LM , Calvo N . Mandibular fracture after wire suspension reduction technique in patient with HIV. Br J Oral Maxillofac Surg 2000;38:397.

13.

Guaraldi G , Ventura P , Albuzza M , Orlando G , Bedini A , Amorico G , Esposito R . Pathological fractures in AIDS patients with osteopenia and osteoporosis induced by antiretroviral therapy. AIDS 2001; 15:137-138.

14.

Fairfield WP , Finkelstein JS , Klibanski A , Grinspoon SK . Osteopenia in eugonadal men with acquired immune deficiency syndrome wasting syndrome. J Clin Endocrinol Metab 2001;86: 2020-2026.

15.

Paton NI , Macallan DC , Griffin GE , Pazianas M . Bone mineral density in patients with human immunodeficiency virus infection. Calcif Tissue Int 1997;61:30-32.

16.

Anastos K , Hessol N . The association of bone mineral density and HIV infection and antiretroviral treatment in women. 11th Conference on Retroviruses and Opportunistic Infections. February 8-11, 2004. San Francisco, CA, USA. (Abstract 744). Accessed August 14, 2004 from http://www.retroconference.org/2004/cd/Abstract/744.htm

17.

Brown T , Timpone J , Ruppe M , et al. Bone loss associated with abnormalities in glucose metabolism in HIV patients on protease inhibitors (PIs). 9th Conference on Retroviruses and Opportunistic Infections. February 24-28, 2002. Seattle, WA, USA. (Poster 716-T). Accessed August 14, 2004 from http://www.retroconference.org/2002/Abstract/13246.htm

18.

Moore AL , Vashisht A , Sabin CA , et al. Reduced bone mineral density in HIV-positive individuals. AIDS 2001;15:1731-1733.

19.

Nolan D , Upton R , McKinnon E , et al. Stable or increasing bone mineral density in HIV-infected patients treated with nelfinavir or indinavir. AIDS 2001;15:1275-1280.

20.

Mondy K , Yarasheski K , Powderly WG , et al. Longitudinal evolution of bone mineral density and bone markers in HIV-infected individuals. Clin Infect Dis 2003;36:482-490.

21.

Gold J , Pocock N , Li Y . Albion St Centre Osteoporosis and HIV Study Group . Bone mineral density abnormalities in patients with HIV infection. J Acquir Immune Defic Syndr 2002;30:131-132.

22.

Wu F , Mason B , Horne A , Ames R , et al. Fractures between the ages of 20 and 50 years increase women’s risk of subsequent fractures. Arch Intern Med 2002;162:33-36.

23.

Cooper C. The crippling consequences of fractures and their impact on quality of life. Am J Med 1997;103:12S-17S.

24.

Johnell O. The socioeconomic burden of fractures: Today and in the 21st century. Am J Med 1997;103:20S-25S.

25.

Browner WS , Seeley DG , Vogt TM , Cummings SR . Non-trauma mortality in elderly women with low bone mineral density. Lancet 1991;338: 355-358.

26.

Cooper C , Atkinson EJ , Jacobsen SJ , O’Fallon WM , Melton LJ 3rd. Population-based study of survival after osteoporotic fractures. Am J Epidemiol 1993;137:1001-1005.

27.

Kado DM , Browner WS , Palermo L , Nevitt MC , Genant HK , Cummings SR . Vertebral fractures and mortality in older women: A prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med 1999;159: 1215-1220.