Osteoporosis and fracture risk among individuals with HIV: a systematic review and meta-analysis

Abstract

Abstract Objective This meta-analysis was conducted to examine the prevalence of bone loss and fractures in people living with HIV (PLWHIV). These individuals are at increased risk of bone-related complications due to antiretroviral therapy, immunologic dysregulation, and lifestyle factors. The review also assessed the comparative risk of bone loss and fractures in PLWHIV compared with the general population without HIV. Methods An extensive search was conducted on international databases, such as PubMed (Medline), Scopus, Web of Science, Cumulated Index to Nursing and Allied Health Literature (CINAHL), and EMBASE, to find relevant studies published until January 2024. Cross-sectional and cohort studies were chosen according to the goals of the study. Random-effects meta-analyses were performed to combine the prevalence estimates and risk ratios (RRs). Results The meta-analysis analyzed 16 studies on fractures prevalence, 19 studies on osteopenia prevalence, 25 studies on osteoporosis prevalence, and 11 studies on RR. 21% of PLWHIV had fractures, 43% had osteopenia, and 14% had osteoporosis. Osteopenia and osteoporosis were found in 36% (95% CI 20–55%) and 5% (95% CI 1–10%) of cases in the pelvic bone. The prevalence of osteopenia and osteoporosis in the spine was calculated to be 37% (95% CI 29–45%) and 14% (95% CI 8–22%), respectively. The prevalence of vertebral fractures stood at 16%. It was discovered that having HIV disease raised the risk of developing osteoporosis by 25% (RR: 1.25; 95% CI 0.87–1.78). Conclusion The findings of this meta-analysis reveal that PLWHIV have a much greater prevalence of fractures, reduced bone density, and risk of fractures when compared to the general population. These results emphasize the significant impact of skeletal health issues linked to HIV infection and emphasize the importance of improving clinical care and implementing specific public health measures to address this critical complication.

Keywords

• HIV
• Fractures
• Osteoporosis
• Osteopenia
• Evidence synthesis