Bone mineral abnormalities in persons with HIV infection: signal or noise?

Bone disorders such as osteopenia, osteoporosis, osteomalacia, and osteonecrosis have been reported in persons infected with HIV. Any specific contributions of HIV infection and its treatment to these disorders are unclear. The prevalence estimates vary widely among studies and may be influenced by the presence or absence of antiretroviral therapy, wasting and lipodystrophy, severity of HIV disease, and overlapping established bone mineral loss or osteonecrosis risk factors. Limited data exist regarding the consequences of HIV treatment choice and treatment modification on bone mineral density (BMD) outcomes. Available data suggest that while BMD may initially decline modestly afer the start of antiretroviral therapy, there is then a gradual recovery in BMD over time. This may reflect the observation that BMD declines as HIV disease progresses and that this decline may be arrested and partially corrected with successful antiretroviral therapy.