Review Article

Modern Antiretroviral Therapy and Fracture Risk

Nikolaos Inglezos^1,2

1. 3^rd Department of Orthopaedic Surgery, General Hospital of Attica KAT, Greece
2. Postgraduate program “Metabolic Bone Diseases”, National and Kapodistrian University of Athens, Medical School, Athens

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Keywords: Antiretroviral therapy, Bone mineral density, Fracture risk, HIV, Osteoporosis

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Abstract

Excessive bone loss has been noticed in HIV patients, under no antiretroviral therapy, suggesting that HIV is an independent factor for osteoporosis. However, it is still controversial if bone mineral density reduction and increased fracture risk is related to HIV itself or to antiretroviral therapy, with a contribution from both likely. The purpose of this study is to review the association of modern antiretroviral drugs with fracture risk. A simple literature review was performed in the PubMed database. The final search identified 21 studies (6 prospective randomized studies, 4 prospective cohort studies, 3 cross-sectional studies, 4 case–control studies, and 4 retrospective studies). It appears that the pathogenesis of osteoporotic fractures in AIDS patients is multifactorial. The majority of studies show mixed results regarding the effect of most antiretroviral drugs. Further high-quality research is needed to fully elucidate the role of antiretroviral drugs in the pathogenesis of bone loss, osteoporosis, and osteoporotic fractures in HIV-infected patients.

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