HIV Infection and Metabolic Bone Disease

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HIV Infection and Metabolic Bone Disease

Slide Presentation
April 2010
Dolores Shoback, MD

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Slide 1.

HIV Infection and Metabolic Bone Disease

Slide 1.

HIV and Bone Disease

Slide 2.

Topics

Slide 3.

Osteoporosis

Slide 4.

Aging: Male vs Female Skeleton

Slide 5.

Figure 1: Bone Mass Lifecycle

Slide 6.

Fracture Incidence: Men vs Women

Slide 7.

Hip Fractures Are Associated with Increased Morbidity and Mortality

Slide 8.

Survival after Hip Fracture

Slide 9.

BMD Measurements -- DXA

Slide 10.

BMD Measurements -- DXA

Slide 11.

Clinical Risk Factors for Osteoporotic Fractures

Slide 12.

Age and Fracture Risk vs BMD in the General Population

Slide 13.

FRAX: WHO Algorithm for Absolute Fracture Risk

Slide 14.

FRAX: Calculating 10-Year Fracture Probability

Slide 15.

NOF -- "Clinician's Guide to Prevention and Treatment of Osteoporosis" (2008)

Slide 16.

NOF -- "Clinician's Guide to Prevention and Treatment of Osteoporosis" (2008) (cont'd)

Slide 17.

Vitamin D: Production and Metabolism

Slide 18.

The 25(OH)D Continuum Controversy

Slide 19.

Why Do We Lose Bone Mass with Menopause and Normal Aging? (and with HIV Infection)

Slide 20.

Bone Mass -- Remodeling

Slide 21.

Slide 22

Slide 22.

HIV and Bone

Slide 23.

#1 -- What Is the Epidemiology of Low BMD in HIV-Infected Patients and Are They at Greater Risk of Fractures?

Slide 24.

Metaanalysis of 11 Cross-Sectional Studies (Brown and Qaqish, AIDS 2006)

Slide 25.

Metaanalysis of 7 Cross-Sectional Studies

Slide 26.

Metaanalysis of 12 Cross-Sectional Studies (Brown and Qaqish, AIDS 2006)

Slide 27.

Caveats of Metaanalyses (Brown and Qaqish, AIDS 2006)

Slide 28.

Fracture Prevalence in HIV-Infected Patients (N = 8,525) vs Noninfected Controls (N = 2.2 million): Partners Health Care System (Retrospective)

Slide 29.

Fracture Prevalence in HIV-Infected vs Noninfected Controls

Slide 30.

#2 -- What Are Special Risk Factors for Bone Loss?

Slide 31.

What Are Special Risk Factors for Bone Loss? (cont'd)

Slide 32.

Role of Specific ART in Bone Loss -- Controversial

Slide 33.

Role of Specific ART in Bone Loss -- Controversial

Slide 34.

#3 -- What Is the Vitamin D Status of HIV-Infected Patients?

Slide 35.

What Is the Vitamin D Status of HIV-Infected Patients? (cont'd)

Slide 36.

What Is the Vitamin D Status of HIV-Infected Patients? (cont'd)

Slide 37.

#4 -- Who Should Be Screened for Low BMD?

Slide 38.

Who Should Be Screened for Low BMD? (cont'd)

Slide 39.

#5 -- When Should Treatment Be Started and What Treatment Works?

Slide 40.

When Should Treatment Be Started and What Treatment Works? (cont'd)

Slide 41.

Conclusions

Slide 42.

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