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Screening for bone fracture risk should be routine for over-40s with HIV, new guidelines recommend
Keith Alcorn, 2015-02-02 14:40:00

Screening for fracture risk should be a routine part of HIV care for all over-40s, and all postmenopausal women, all men over 50 and people at high risk for fractures of any age should undergo DEXA screening (a type of X-ray) to assess bone mineral density and their need for treatment, experts on bone disorders recommend in new guidelines published online in the journal Clinical Infectious Diseases.

Low bone mineral density and fragility fractures occur more frequently in people living with HIV than in other people of a similar age. Several studies conducted in US men and women living with HIV have shown that the rate of fractures of the spine, hip and wrist is approximately 60% higher than in the general population.

It is unclear whether HIV causes bone mineral loss, also known as osteoporosis, but bone mineral density usually declines by 2- 6% in the first two years after starting antiretroviral treatment. People living with HIV also tend to have a high frequency of risk factors for osteoporosis including smoking, high alcohol consumption, low body weight and poor nutrition. As the population of people living with HIV ages, bone mineral loss is becoming a more serious problem.

International expert guidelines for management of bone loss were developed by 34 experts from 16 countries. Their recommendations cover screening, diagnosis and monitoring of bone disease and are graded accorded to the strength of evidence available.