Jamshaid Maryam, Heidari Amirmohammad, Hassan Ahmed, Mital Dushyant, Pearce Oliver, Panourgia Maria, Ahmed Mohamed H
Department of Trauma and Orthopaedics, Liverpool University Hospital NHS Trust, Liverpool L69 3BX, UK.
School of Medicine, University of Liverpool, Liverpool L69 3BX, UK.
Pathogens. 2024 Sep 19;13(9):811. doi: 10.3390/pathogens13090811.
Post-menopausal women living with Human Immunodeficiency Virus (WLHIV) face an increased risk of bone fractures due to the relationship between HIV-related factors and menopause. This narrative review aims to summarise the current knowledge about fracture risk among post-menopausal WLHIV in particular looking at hormonal changes, combined antiretroviral therapy (cART), lifestyle factors, and psychosocial implications. We also profiled a summary of the significant, recent studies of post-menopausal WLHIV residing in low-income countries (LIC).
A thorough search of the literature was performed across PubMed, Medline, Scopus, and Google Scholar, focussing on studies published between 2000 and 2024. Inclusion criteria entailed original research, reviews, and meta-analyses addressing bone mineral density (BMD), fracture incidence, and related risk factors in post-menopausal WLHIV.
The review identified 223 relevant studies. Post-menopausal WLHIV exhibit significantly lower BMD and higher fracture rates compared to both HIV-negative post-menopausal women and pre-menopausal WLHIV. cART, particularly tenofovir disoproxil fumarate (TDF), contributes to reduced BMD. Menopausal status exacerbates this risk through decreased oestrogen levels, leading to increased bone resorption. Moreover, lifestyle choices such as smoking, alcohol consumption, and low physical activity are more prevalent in PWHIV, which further elevates fracture risk. Different psychosocial factors may make WLWHIV more vulnerable at this stage of their life, such as depression, isolation, stigma, and housing and nutritional issues. Women living in LICs face a variety of challenges in accessing HIV care. There are gaps in research related to the prevalence of osteoporosis and bone loss in post-menopausal WLHIV in LICs.
Post-menopausal women living with HIV face a significantly higher risk of bone loss and fractures due to the combined effects of HIV and menopause. Antiretroviral therapy (particularly TDF), lifestyle factors, and psychosocial challenges exacerbate this risk. There is a need for careful selection of cART, hormone replacement therapy (HRT), and emerging treatments such as Abaloparatide. A holistic approach including lifestyle changes and psychosocial support is crucial to reduce fracture risk in WLHIV, especially in low-income countries.
由于与艾滋病毒相关的因素和绝经之间的关系，感染人类免疫缺陷病毒（HIV）的绝经后女性面临骨折风险增加的问题。本叙述性综述旨在总结当前关于绝经后感染HIV女性骨折风险的知识，特别关注激素变化、联合抗逆转录病毒疗法（cART）、生活方式因素和心理社会影响。我们还概述了近期对低收入国家（LIC）绝经后感染HIV女性的重要研究。
在PubMed、Medline、Scopus和谷歌学术上对文献进行了全面检索，重点关注2000年至2024年间发表的研究。纳入标准包括针对绝经后感染HIV女性的骨密度（BMD）、骨折发生率及相关危险因素的原创研究、综述和荟萃分析。
该综述确定了223项相关研究。与未感染HIV的绝经后女性和绝经前感染HIV女性相比，绝经后感染HIV女性的骨密度显著更低，骨折率更高。cART，尤其是替诺福韦酯（TDF），会导致骨密度降低。绝经状态通过降低雌激素水平加剧了这种风险，导致骨吸收增加。此外，吸烟、饮酒和低体力活动等生活方式选择在感染HIV的人群中更为普遍，这进一步增加了骨折风险。不同的心理社会因素可能使感染HIV的绝经后女性在这一人生阶段更加脆弱，如抑郁、孤立、耻辱以及住房和营养问题。生活在低收入国家的女性在获得HIV护理方面面临各种挑战。关于低收入国家绝经后感染HIV女性骨质疏松症和骨质流失患病率的研究存在空白。
由于HIV和绝经的综合影响，感染HIV的绝经后女性面临骨质流失和骨折的风险显著更高。抗逆转录病毒疗法（尤其是TDF）、生活方式因素和心理社会挑战加剧了这种风险。需要谨慎选择cART、激素替代疗法（HRT）以及阿巴洛肽等新兴疗法。包括生活方式改变和心理社会支持在内的整体方法对于降低感染HIV女性的骨折风险至关重要，尤其是在低收入国家。
