Common bone diseases in HIV
Does bone diseases occur more commonly in HIV patients?
• Osteoporosis: The risk of low bone mass is three times more common in HIV-infected patients. The cause is multifactorial including vitamin D deficiency, hypogonadism, low body mass index, direct and indirect ART side effects, and chronic inflammation. The increasing life expectancy of HIV patients and increase in ART use/duration of therapy will increase the prevalence of bone disease amongst patients. Therapy includes calcium, vitamin D, and bisphosphonate therapy based on current recommendations.
• Osteonecrosis (avascular necrosis): Osteonecrosis can occur in any joint, with the hip being most common. Bilateral disease and earlier onset is more common in HIV patients. The prevalence is 4% to 5%. Risk factors include dyslipidemia associated with protease inhibitors, corticosteroid use, and the HIV infection itself when the patient has a very low CD4 counts (<60 cells/μL).
• Hypertrophic osteoarthropathy: can develop in patients with Pneumocystis jiroveci pneumonia. Treatment of the pneumonia improves the hypertrophic osteoarthropathy.