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HIV Infection, Antiretrovirals and Bone Disease
Slide Presentation
March 20, 2013
Steven T Harris MD, FACP

Click on slide thumbnails to view full-size image.

Slide 1.
HIV Infection, Antiretrovirals and Bone Disease
Slide 1.
HIV and Bone: Key Topics
Slide 2.
HIV and Bone: Key Topics, Continued
Slide 3.
Fracture Prevalence and HIV Infection
Slide 4.
What Is Bone?
Slide 5.
Normal Bone Remodeling Sequence
Slide 6.
Metabolism and Function of Vitamin D
Slide 7.
Pathophysiology of Osteoporosis: Overview
Slide 8.
Unbalanced Remodeling
Slide 9.
Bone Loss
Slide 10.
Microarchitectural Deterioration in Osteoporosis
Slide 11.
Bone Density: Major Determinant of Fracture Risk
Slide 12.
Pathogenesis of Osteoporosis
Slide 13.
DXA Spine
Slide 14.
DXA Hip
Slide 15.
DXA Interpretation
Slide 16.
WHO Bone Density Criteria
Slide 17.
Bone Densitometry: Caveats
Slide 18.
Risk Factors for Fracture: Beyond Age + T-score
Slide 19.
Calculating Absolute Fracture Risk: FRAX®
Slide 20.
HIV and Bone
Slide 21.
Reduced BMD in HIV+ Individuals
Slide 22.
Many Potential Contributors to Decreased BMD in Patients With HIV
Slide 23.
Bone Densitometry in HIV Patients: IDSA Guidelines
Slide 24.
Initiation of ART Is Associated With BMD Loss of ~2% to ~6% Through 96 Weeks
Slide 25.
A5224s: Mean (95% CI) Percent Change in Hip and Spine BMD (ITT)
Slide 26.
Management of BMD
Slide 27.
Objective of Intervention
Slide 28.
Evaluate for Other Causes of Bone Loss, Especially Those That Are Serious or Correctable
Slide 29.
Evaluation Of The Patient With Low BMD
Slide 30.
Laboratory Test Table
Slide 31.
Importance of 24-hour Urine Calcium
Slide 32.
NOF Guidelines: Treatment Initiation in Postmenopausal Women and Men ≥50
Slide 33.
Treatment Summary
Slide 34.
Non-Pharmacological Options
Slide 36.
Institute of Medicine Recommendations and Response
Slide 36.
National Osteoporosis Foundation and AACE Recommendations
Slide 37.
Studies of Calcium and Vitamin D Supplements
Slide 38.
Correction of Vitamin D Deficiency
Slide 39.
Calcium and Vitamin D Summary
Slide 40.
FDA-Approved Therapeutic Options: Postmenopausal Women
Slide 41.
Normal Coupling of Bone Remodeling
Slide 42.
Antiresorptive Treatment: Summary
Slide 43.
Anti-resorptive Agents: Clinical Trial Results
Slide 44.
ACTG 5163: Effect of Alendronate on BMD in HIV-Infected Patients
Slide 45.
Effect of Zoledronic Acid on BMD in HIV+ Men
Slide 46.
Conclusions
Slide 47.
Conclusions
Slide 48.

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