|Osteopenia and Osteoporosis
||cART, especially following initiation and regardless of regimen
Specific Agents of Possible Concern:
- PIs, especially LPV/r
- Any age; greatest risk in months after initiation of associated ARV
Most commonly asymptomatic; fracture (rare)
- Osteoporosis diagnosis in children requires clinical evidence of bone fragility (e.g., fracture with minimal trauma) and cannot rely solely on measured low BMD.
- 7% of a U.S. cohort had a BMD z score of
≤ –2.0 (87% treated with cART).
- 24% to 32% of Thai and Brazilian adolescents had a BMD z score of
≤ –2.0 (92% to 100% treated with cART).
|Longer duration of HIV infection
Greater severity of HIV disease
Growth delay, pubertal delay
- Ensure sufficient calcium and vitamin D intake.
- Encourage weight-bearing exercise.
- Minimize modifiable risk factors (e.g., smoking, low BMI, steroid use).
- Assess nutritional intake (calcium, vitamin D, and total calories).
- Obtain serum 25-OH-vitamin D.a
- Obtain DXA.b
|Ensure sufficient calcium and vitamin D intake.
Encourage weight-bearing exercise.
Reduce modifiable risk factors (e.g., smoking, low BMI, use of steroids, medroxyprogesterone).
Role of bisphosphonates not established in children
Consider change in ARV regimen.