An international panel has released new guidelines on the management of bone density decline among people with HIV, aidsmap reports. Published in Clinical Infectious Diseases, the guidelines were created by 34 medical experts from 16 nations.

The guidelines recommend that those at high risk of fragility fractures receive DEXA screening to measure bone density. High-risk people include those who have already had such fractures, people at high risk for falling, and those who are taking glucocorticoids (a class of steroid) for three months or longer.

The FRAX scoring system, which determines fracture risk based on someone’s lifestyle and medical history, can be used instead of a DEXA scan for men in their 40s and premenopausal women 40 and older. FRAX is recommended every three years for these people. If the results suggest that an individual has a more than 10 percent risk of a fracture during the next decade, a DEXA scan is recommended.

For HIV-positive people with osteoporosis or low bone mineral density, clinicians should discuss prescribing antiretroviral (ARV) regimens that do not contain Viread (tenofovir, which is included in Truvada and several other combination tablets) or boosted protease inhibitors, the two of which apparently lead to greater bone loss than other ARVs.

Men between ages 50 and 70 who are at risk for fractures should consume 1,000 milligrams of calcium each day, while men over 70 and women over 50 are advised to take in 1,300 mg a day. Clinicians should also test for Vitamin D levels, and supplementation should be given if necessary.

Lifestyle recommendations for HIV-positive people with osteoporosis include engaging in weight-bearing and muscle strengthening exercises, quitting smoking, and cutting back on drinking.

Fosamax (alendronate) is recommended for osteoporosis treatment. If that drug is not a success, an alternative is intravenous zoledronic acid, given once annually.

To read the aidsmap story, click here.

To read the guidelines, click here.