Calcified Tissue International

, Volume 105, Issue 4, pp 423–429 | Cite as

Long-Term Stable Bone Mineral Density in HIV-Infected Men Without Risk Factors for Osteoporosis Treated with Antiretroviral Therapy

  • Mark J. BollandEmail author
  • Anne M. Horne
  • Simon E. Briggs
  • Mark G. Thomas
  • Ian R. Reid
  • Greg D. Gamble
  • Andrew Grey
Original Research



Most prospective studies of bone mineral density (BMD) in HIV-infected cohorts taking antiretroviral therapy (ART) have been of short duration, typically < 3 years. Such studies have reported short-term stable or increasing BMD. We assessed whether this BMD stability persists for > 10 years in middle-aged and older men established on ART.


A 12-year, prospective, longitudinal study in 44 HIV-infected men treated with ART who had measurements of BMD at the lumbar spine, proximal femur and total body at baseline, 2, 6 and 12 years.


At baseline, the mean age of participants was 49 years, the mean duration of HIV infection was 8 years, and the mean duration of ART was 50 months. After 12 years, BMD increased by 6.9% (95% CI 3.4 to 10.3) at the lumbar spine, and remained stable (range of BMD change: − 0.6% to 0.0%) at the total hip, femoral neck and total body. Only two individuals had a decrease of > 10% in BMD at any site during follow-up and both decreases in BMD were explained by co-morbid illnesses.


BMD remained stable over 12 years in middle-aged and older HIV-infected men treated with ART. Monitoring BMD in men established on ART who do not have risk factors for BMD loss is not necessary.


HIV Bone density Osteopenia Osteoporosis Body weight 


Author Contributions

MB, AH, SB, MT, IR, GG and AG designed the study. MB drafted the manuscript and is the guarantor. MB and AH ran the study. MB and GG did the statistical analyses. All authors revised the paper critically for intellectual content and approved the final version. All authors agree to be accountable for the work and to ensure that any questions relating to the accuracy and integrity of the paper are investigated and properly resolved.


This study was funded by the Health Research Council of New Zealand.

Compliance with Ethical Standards

Conflict of interest

Mark Bolland, Anne Horne, Simon Briggs, Mark Thomas, Ian Reid, Greg Gamble and Andrew Grey declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

The study received ethical approval from the Northern X Regional ethics committee, and all participants provided written, informed consent.


  1. 1.
    Borderi M, Gibellini D, Vescini F et al (2009) Metabolic bone disease in HIV infection. AIDS 23:1297–1310CrossRefGoogle Scholar
  2. 2.
    McComsey GA, Tebas P, Shane E et al (2010) Bone disease in HIV infection: a practical review and recommendations for HIV care providers. Clin Infect Dis 51:937–946CrossRefGoogle Scholar
  3. 3.
    Biver E, Calmy A, Aubry-Rozier B et al (2019) Diagnosis, prevention, and treatment of bone fragility in people living with HIV: a position statement from the Swiss Association against Osteoporosis. Osteoporos Int 30(5):1125–1135CrossRefGoogle Scholar
  4. 4.
    Bolland MJ, Grey A, Reid IR (2015) Skeletal health in adults with HIV infection. Lancet Diabetes Endocrinol 3:63–74CrossRefGoogle Scholar
  5. 5.
    Bolland MJ, Wang TK, Grey A et al (2011) Stable bone density in HAART-treated individuals with HIV: a meta-analysis. J Clin Endocrinol Metab 96:2721–2731CrossRefGoogle Scholar
  6. 6.
    Bolland MJ, Grey A, Horne AM et al (2012) Stable bone mineral density over 6 years in HIV-infected men treated with highly active antiretroviral therapy (HAART). Clin Endocrinol 76:643–648CrossRefGoogle Scholar
  7. 7.
    Bolland MJ, Grey AB, Horne AM et al (2007) Bone mineral density remains stable in HAART-treated HIV-infected men over 2 years. Clin Endocrinol 67:270–275CrossRefGoogle Scholar
  8. 8.
    Bolland MJ, Grey AB, Horne AM et al (2007) Annual zoledronate increases bone density in highly active antiretroviral therapy-treated human immunodeficiency virus-infected men: a randomized controlled trial. J Clin Endocrinol Metab 92:1283–1288CrossRefGoogle Scholar
  9. 9.
    Bolland MJ, Grey AB, Horne AM et al (2006) Bone mineral density is not reduced in HIV-infected Caucasian men treated with highly active antiretroviral therapy. Clin Endocrinol 65:191–197CrossRefGoogle Scholar
  10. 10.
    Bolland MJ, Grey A, Horne AM et al (2008) Osteomalacia in an HIV-infected man receiving rifabutin, a cytochrome P450 enzyme inducer: a case report. Ann Clin Microbiol Antimicrob 7:3CrossRefGoogle Scholar
  11. 11.
    Meyer HE, Sogaard AJ, Falch JA et al (2008) Weight change over three decades and the risk of osteoporosis in men: the Norwegian Epidemiological Osteoporosis Studies (NOREPOS). Am J Epidemiol 168:454–460CrossRefGoogle Scholar
  12. 12.
    Cassetti I, Madruga JV, Suleiman JM et al (2007) The safety and efficacy of tenofovir DF in combination with lamivudine and efavirenz through 6 years in antiretroviral-naive HIV-1-infected patients. HIV Clin Trials 8:164–172CrossRefGoogle Scholar
  13. 13.
    Madeddu G, Spanu A, Solinas P et al (2015) Different impact of NNRTI and PI-including HAART on bone mineral density loss in HIV-infected patients. Eur Rev Med Pharmacol Sci 19:4576–4589Google Scholar
  14. 14.
    Giacomet V, Maruca K, Ambrosi A et al (2017) A 10-year follow-up of bone mineral density in HIV-infected youths receiving tenofovir disoproxil fumarate. Int J Antimicrob Agents 50:365–370CrossRefGoogle Scholar
  15. 15.
    Grant PM, Kitch D, McComsey GA et al (2016) Long-term bone mineral density changes in antiretroviral-treated HIV-infected individuals. J Infect Dis 214:607–611CrossRefGoogle Scholar
  16. 16.
    Negredo E, Langohr K, Bonjoch A et al (2018) High risk and probability of progression to osteoporosis at 10 years in HIV-infected individuals: the role of PIs. J Antimicrob Chemother 73:2452–2459CrossRefGoogle Scholar
  17. 17.
    Erlandson KM, Lake JE, Sim M et al (2018) Bone mineral density declines twice as quickly among HIV-infected women compared with men. J Acquir Immune Defic Syndr 77:288–294CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of MedicineUniversity of AucklandAucklandNew Zealand
  2. 2.Department of Infectious DiseasesAuckland City HospitalAucklandNew Zealand
  3. 3.Department of Molecular Medicine and PathologyUniversity of AucklandAucklandNew Zealand
  4. 4.Bone and Joint Research Group, Department of MedicineUniversity of AucklandAucklandNew Zealand

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