Bone Loss and Fractures in Post-Menopausal Women Living with HIV: A Narrative Review

被引:0
作者
Jamshaid, Maryam [1 ,2 ]
Heidari, Amirmohammad [1 ,2 ]
Hassan, Ahmed [3 ]
Mital, Dushyant [4 ]
Pearce, Oliver [5 ]
Panourgia, Maria [6 ,7 ]
Ahmed, Mohamed H. [6 ,7 ,8 ,9 ]
机构
[1] Liverpool Univ Hosp NHS Trust, Dept Trauma & Orthopaed, Liverpool L69 3BX, England
[2] Univ Liverpool, Sch Med, Liverpool L69 3BX, England
[3] Alexandria Univ, Fac Med, Alexandria 21500, Egypt
[4] Milton Keynes Univ Hosp NHS Fdn Trust, Dept HIV & Blood Borne Virus, Milton Keynes MK6 5LD, England
[5] Milton Keynes Univ Hosp NHS Fdn Trust, Dept Trauma & Orthopaed, Milton Keynes MK6 5LD, England
[6] Milton Keynes Univ Hosp NHS Fdn Trust, Dept Geriatr Med, Milton Keynes MK6 5LD, England
[7] Univ Buckingham, Fac Med & Hlth Sci, Buckingham MK18 1EG, England
[8] Milton Keynes Univ Hosp NHS Fdn Trust, Dept Med, Milton Keynes MK6 5LD, England
[9] Milton Keynes Univ Hosp NHS Fdn Trust, HIV Metab Clin, Milton Keynes MK6 5LD, England
来源
PATHOGENS | 2024年 / 13卷 / 09期
关键词
bone loss; fractures; post-menopausal; women; living with HIV; HUMAN-IMMUNODEFICIENCY-VIRUS; CARDIOVASCULAR RISK-FACTORS; VITAMIN-D STATUS; MINERAL DENSITY; ANTIRETROVIRAL THERAPY; FRAGILITY FRACTURES; INFECTED PATIENTS; THYROID-FUNCTION; BODY-COMPOSITION; TASK-FORCE;
D O I
10.3390/pathogens13090811
中图分类号
Q93 [微生物学];
学科分类号
071005 ; 100705 ;
摘要
Introduction: Post-menopausal women living with Human Immunodeficiency Virus (WLHIV) face an increased risk of bone fractures due to the relationship between HIV-related factors and menopause. This narrative review aims to summarise the current knowledge about fracture risk among post-menopausal WLHIV in particular looking at hormonal changes, combined antiretroviral therapy (cART), lifestyle factors, and psychosocial implications. We also profiled a summary of the significant, recent studies of post-menopausal WLHIV residing in low-income countries (LIC). Methods: A thorough search of the literature was performed across PubMed, Medline, Scopus, and Google Scholar, focussing on studies published between 2000 and 2024. Inclusion criteria entailed original research, reviews, and meta-analyses addressing bone mineral density (BMD), fracture incidence, and related risk factors in post-menopausal WLHIV. Results: The review identified 223 relevant studies. Post-menopausal WLHIV exhibit significantly lower BMD and higher fracture rates compared to both HIV-negative post-menopausal women and pre-menopausal WLHIV. cART, particularly tenofovir disoproxil fumarate (TDF), contributes to reduced BMD. Menopausal status exacerbates this risk through decreased oestrogen levels, leading to increased bone resorption. Moreover, lifestyle choices such as smoking, alcohol consumption, and low physical activity are more prevalent in PWHIV, which further elevates fracture risk. Different psychosocial factors may make WLWHIV more vulnerable at this stage of their life, such as depression, isolation, stigma, and housing and nutritional issues. Women living in LICs face a variety of challenges in accessing HIV care. There are gaps in research related to the prevalence of osteoporosis and bone loss in post-menopausal WLHIV in LICs. Conclusion: Post-menopausal women living with HIV face a significantly higher risk of bone loss and fractures due to the combined effects of HIV and menopause. Antiretroviral therapy (particularly TDF), lifestyle factors, and psychosocial challenges exacerbate this risk. There is a need for careful selection of cART, hormone replacement therapy (HRT), and emerging treatments such as Abaloparatide. A holistic approach including lifestyle changes and psychosocial support is crucial to reduce fracture risk in WLHIV, especially in low-income countries.
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页数:34
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