Department of Pediatrics and Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
Clin Infect Dis. 2010 Oct 15;51(8):937-46. doi: 10.1086/656412.
Low bone mineral density (BMD) is prevalent in human immunodeficiency virus (HIV)-infected subjects. Initiation of antiretroviral therapy is associated with a 2%-6% decrease in BMD over the first 2 years, a decrease that is similar in magnitude to that sustained during the first 2 years of menopause. Recent studies have also described increased fracture rates in the HIV-infected population. The causes of low BMD in individuals with HIV infection appear to be multifactorial and likely represent a complex interaction between HIV infection, traditional osteoporosis risk factors, and antiretroviral-related factors. In this review, we make the point that HIV infection should be considered as a risk factor for bone disease. We recommend screening patients with fragility fractures, all HIV-infected post-menopausal women, and all HIV-infected men ⩾50 years of age. We also discuss the importance of considering secondary causes of osteoporosis. Finally, we discuss treatment of the more severe cases of bone disease, while outlining the caveats and gaps in our knowledge.
骨密度降低（BMD）在人类免疫缺陷病毒（HIV）感染者中较为普遍。开始抗逆转录病毒治疗后的前 2 年，BMD 会下降 2%-6%，这与绝经后前 2 年的下降幅度相似。最近的研究还描述了 HIV 感染者中骨折发生率的增加。HIV 感染者 BMD 降低的原因似乎是多因素的，可能是 HIV 感染、传统骨质疏松危险因素和抗逆转录病毒相关因素之间复杂相互作用的结果。在这篇综述中，我们指出 HIV 感染应被视为骨病的一个危险因素。我们建议对脆性骨折患者、所有 HIV 感染的绝经后妇女以及所有年龄 ⩾50 岁的 HIV 感染男性进行筛查。我们还讨论了考虑骨质疏松症继发原因的重要性。最后，我们讨论了更严重的骨病的治疗方法，同时概述了我们知识中的注意事项和差距。
