Individuals With HIV Have an Increased Risk of Osteoporosis

A close relationship between HIV and osteoporosis exists, according to a new study published in Medicine.¹ Those diagnosed with HIV have an increased risk of being diagnosed with osteoporosis based on both the independent risk factor of HIV in osteoporosis and the decreased bone density in those diagnosed with HIV.

Patients with HIV have increased risk of being diagnosed with osteoporosis | Image credit: pikselstock - stock.adobe.com

A decrease in bone mineral density is the primary characteristic of osteoporosis, which can cause an increased risk of fracture due to the fragility of the skeleton. Most individuals with osteoporosis are older adults, as the risk of being diagnosed increases with age. HIV is a significant risk factor for osteoporosis due to the infection or certain treatments potentially increasing the risk.² This study aimed to assess the relationship between osteoporosis and HIV infection by using data from the National Health and Nutrition Examination Survey (NHANES).

The NHANES collects data from individuals living in the US to create a representative picture of the country’s health. Patients from this data set were included in the study if they had a history of osteoporosis that was self-reported and based on a diagnosis from a physician and they had a T-score of –2.5 or lower at either the neck or the spine when using a dual energy X-ray. All participants were 18 years or older. Any individuals who were missing data in the data set, were pregnant, or had severe comorbidities were excluded.

Individuals were considered to be diagnosed with HIV if they had a positive test result in the data set. Lumbar spine bone density or femoral neck bone density were used to determine an osteoporosis diagnosis.

There were 3734 participants from the survey who were included in the analysis, with 69 patients with osteoporosis being included. There were 12 cases of osteoporosis in those who were diagnosed with HIV compared with 57 cases in those who were not living with HIV. Those who had osteoporosis had a mean age of 55 years compared with a mean age of 45 years in those who did not have osteoporosis. Only 0.4% of those with osteoporosis were men.

A multivariate logistic regression analysis found that the OR for predicting osteoporosis risk through HIV was 39.98 in the unadjusted analysis and 819.18 when adjusting for covariates, indicating that HIV is a risk factor in osteoporosis.

There were some limitations to this study. There was an imbalance in the number of patients with compared with those without, which could have led to an impact on the statistical analysis. Causal relationships could not be determined due to the cross-sectional design of the study. There was an association between reduced bone mineral density and HIV but the reason for this association could not be determined from this study alone. Future studies should focus on whether this reduced bone mineral density is due to HIV alone or from the long-term effects of antiretroviral therapy.

“This study, through the analysis of the NHANES database, reveals the close relationship between HIV infection and osteoporosis,” the authors concluded. “The bone density of HIV-positive individuals is significantly lower than that of HIV-negative individuals, and HIV infection is an independent risk factor for osteoporosis.”

The researchers indicated that future research should validate these results with more clinical data.

References

1. Li X, Wang JJ, Quan XM, Zhao CS. A multivariate analysis of the impact of HIV infection on the risk of osteoporosis based on the NHANES database. Medicine (Baltimore). 2025;104(36):e44459. doi:10.1097/MD.0000000000044459

2. HIV and osteoporosis. HIVinfo. Updated October 18, 2024. Accessed September 9, 2025. https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-osteoporosis