An international panel of medical experts has released new guidelines on managing declining bone density among people with HIV.

“The guidelines will hopefully further raise awareness of the possibility of osteoporosis and fragility fracture in HIV-infected patients, which is going to be an increasingly important problem as the HIV population ages,” says lead author Todd T. Brown, MD, PhD, an associate professor of medicine and epidemiology at Johns Hopkins University.

The guidelines recommend that those at high risk of fractures resulting from fragile bones receive a DEXA screening to measure bone density. This includes men 50 and older, post-menopausal women, people who have already suffered such fractures, those at greater risk for falling, and those who have been taking glucocorticoids (a class of steroid) for at least three months. 

Men in their 40s and pre-menopausal women 40 and older can use the FRAX scoring system, which measures fracture risk based on lifestyle and medical history. If the results suggest a more than 10 percent risk of a fracture during the next decade, a DEXA scan is recommended. 

For those with osteoporosis or low bone mineral density, clinicians should discuss prescribing antiretroviral (ARV) regimens without Viread (tenofovir) and protease inhibitors boosted by Norvir (ritonavir) or Tybost (cobicistat).

The guidelines also address osteoporosis treatments and provide recommendations about consuming proper amounts of calcium, supplementing vitamin D, and adopting other bone-health-promoting lifestyle changes such as weight training, quitting smoking and cutting back on drinking.