Osteoporosis en los pacientes infectados por el virus de la inmunodeficiencia humana

Abstract

Osteoporosis and osteopenia are highly prevalent in the HIV-infected population due to increased life expectancy since the introduction of antiretroviral therapy. The present article reviews the main pathogenic mechanisms involved in the development of these entities and the currently-recommended strategies for their clinical management, diagnosis and treatment.

Patients with HIV infections have a higher risk of fracture than the general population because of the interaction among nutritional deficiencies, toxic habits, antiretroviral therapy and the viral infection itself. Three of the fundamental mechanisms involved in the physiopathology of these bone diseases are the activation of osteoclastogenesis — mediated by the RANK system — increased osteoblast apoptosis, and deregulation of the vitamin D-PTH axis. Early diagnosis is essential. Screening for reversible secondary causes of osteoporosis, which are highly prevalent in this population, should always be performed and treated appropriately if necessary. Management and treatment should include lifestyle-correction strategies and antiresorptive drugs in individuals at high fracture risk. The only drugs with proven efficacy in HIV-infected patients infected are alendronate and zoledronate.