Diagnosis, prevention, and treatment of bone fragility in people living with HIV: a position statement from the Swiss Association against Osteoporosis

  • E. Biver
  • A. Calmy
  • B. Aubry-Rozier
  • M. Birkhäuser
  • H. A. Bischoff-Ferrari
  • S. Ferrari
  • D. Frey
  • R. W. Kressig
  • O. Lamy
  • K. Lippuner
  • N. Suhm
  • C. MeierEmail author
Consensus Statement


Life expectancy of people living with HIV (PLWH) is reaching similar length as in the general population. Accordingly, age-related comorbidities, including osteoporosis, are increasing. Fracture risk is higher and increases approximately 10 years earlier in PLWH. Classical risk factors of bone fragility are highly prevalent in PLWH but factors specific for HIV infection itself and the type of antiretroviral therapy (ART) (triple combination antiretroviral therapy) regimen (especially tenofovir and protease inhibitors) also contribute to bone loss. The majority of bone loss occurs during virus activity and at initiation of ART (immune reconstitution) and is associated with an increase of bone resorption (upregulation RANKL). Recent data indicate that calcium and vitamin D supplements as ART initiation lower BMD loss. The reduction of tenofovir plasma concentrations with tenofovir alafenamide attenuates BMD loss but it remains unknown whether it will contribute to reduce fracture risk. Hence, special considerations for the management of bone fragility in PLWH are warranted. Based on the current state of epidemiology and pathophysiology of osteoporosis in PLWH, we provide the consensus of the Swiss Association against Osteoporosis on best practice for diagnosis, prevention, and management of osteoporosis in this population. Periodic assessment of fracture risk is indicated in all HIV patients and general preventive measures should be implemented. All postmenopausal women, men above 50 years of age, and patients with other clinical risk for fragility fractures qualify for BMD measurement. An algorithm clarifies when treatment with bisphosphonates and review of ART regimen in favour of more bone-friendly options are indicated.


Bone fragility Diagnosis HIV Management Osteoporosis Prevention 



The authors thank Dr. Isabel Hartmann for manuscript editing.

Compliance with ethical standards

Conflicts of interest

Alexandra Calmy has received travel grants from Gilead and unrestricted educational grants from Gilead, ViiV, MSD, and AbbVie. Emmanuel Biver, Bérengère Aubry-Rozier, Martin Birkhäuser, Heike A. Bischoff-Ferrari, Serge Ferrari, Diana Frey, Reto W. Kressig, Olivier Lamy, Kurt Lippuner, Norbert Suhm, and Christian Meier declare that they have no conflict of interest.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  • E. Biver
    • 1
    return OK on get
  • A. Calmy
    • 2
  • B. Aubry-Rozier
    • 3
  • M. Birkhäuser
    • 4
  • H. A. Bischoff-Ferrari
    • 5
  • S. Ferrari
    • 1
  • D. Frey
    • 6
  • R. W. Kressig
    • 7
  • O. Lamy
    • 3
  • K. Lippuner
    • 8
  • N. Suhm
    • 9
  • C. Meier
    • 10
    Email author
  1. 1.Division of Bone Diseases, Geneva University Hospitals and Faculty of MedicineUniversity of GenevaGenevaSwitzerland
  2. 2.HIV/Aids Unit, Division of Infectious Diseases, Geneva University Hospitals and Faculty of MedicineUniversity of GenevaGenevaSwitzerland
  3. 3.Center of Bone DiseasesLausanne University HospitalLausanneSwitzerland
  4. 4.Gynecological Endocrinology and Reproductive MedicineUniversity of BerneBaselSwitzerland
  5. 5.Department of Geriatrics and Aging ResearchUniversity of Zurich and University Hospital of ZurichZurichSwitzerland
  6. 6.Division of RheumatologyUniversity Hospital ZürichZürichSwitzerland
  7. 7.University Center for Medicine of Aging, Basel Mobility CenterUniversity of BaselBaselSwitzerland
  8. 8.Department of Osteoporosis, University HospitalUniversity of BerneBerneSwitzerland
  9. 9.Department of Orthopedics and Traumatology, Geriatric Fracture CenterUniversity Hospital BaselBaselSwitzerland
  10. 10.Division of Endocrinology, Diabetology & MetabolismUniversity Hospital and University of BaselBaselSwitzerland

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