Bone Biomarkers in HIV

  • Mark BlochEmail author
  • Giovanni GuaraldiEmail author
Reference work entry
Part of the Biomarkers in Disease: Methods, Discoveries and Applications book series (BDMDA)


HIV infection is associated with higher rates of low bone density and fragility fracture, occurring at an earlier age and to a greater extent with ageing in those with HIV, compared to the general population. These outcomes result from a combination of direct HIV effect on bone turnover, the effects of immune pertubation, as well as the inflammatory effect caused by HIV viraemia. Additionally those with HIV have higher rates of lifestyle risk factors as well as higher rates of co-morbidities that increase the biomarkers of bone formation and resorption, and correlate with increased bone turnover and low bone density.

Treatment with antiretroviral therapy, particularly with nucleoside analogues such tenofovir disoproxil fumarate, and protease inhibitor therapy, results in increased bone turnover and lower bone density. These changes are most prominent in the first year of antiretroviral therapy, and then tend to plateau. Changes in bone biomarkers predict the changes in bone turnover and bone density with antiretroviral therapy. Bone biomarkers and bone mineral density have been demonstrated to improve with changes to components of antiretroviral regimens.

Bone biomarkers have been used for research purposes in predicting and monitoring bone turnover and bone density changes in HIV. However the use of bone biomarkers is not yet developed to routine clinical application in HIV management.


HIV Antiretroviral therapy Bone biomarkers Osteoporosis Fracture 

List of Abbreviations


Acquired immunodeficiency syndrome


Alkaline phosphatase


Antiretroviral therapy


Bone-specific alkaline phosphatase


Bone mineral density


Body mass index


Carboxyterminal collagen telopeptides




Dual-energy x-ray absorptiometry


Fracture Risk Assessment Tool




Human immunodeficiency virus




Carboxyterminal cross-linked telopeptide of type I collagen


Interleukin 6


Integrase strand transfer inhibitor


Immune inflammatory reconstitution syndrome


Multicenter AIDS cohort study


Noninfectious comorbidities


Nucleoside/nucleotide reverse transcriptase inhibitor


Non-nucleoside reverse transcriptase inhibitor


Amino-terminal collagen telopeptides






Protease inhibitor/ritonavir-boosted protease inhibitor


C-terminal carboxyterminal peptide of type 1 collagen


N-terminal carboxyterminal peptide of type 1 collagen




Receptor activator of nuclear factor kappa-B


Receptor activator of nuclear factor kappa-B ligand


Relative risk


Strategic timing of antiretroviral treatment


Tenofovir alafenamide


Trabecular bone score


Tenofovir disoproxil fumarate


Tumor necrosis factor


Tumor necrosis factor receptor


Tartrate-resistant acid phosphatase


Tartrate-resistant acid phosphatase isoform 5b


Veterans Aging Cohort Study


Viral protein of regulation


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Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  1. 1.Holdsworth House Medical PracticeDarlinghurstAustralia
  2. 2.Kirby InstituteUniversity of New South WalesSydneyAustralia
  3. 3.Department of Medical and Surgical Sciences for Children and AdultsUniversity of Modena and Reggio EmiliaModenaItaly

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