Screening for bone health in older people with HIV : Uptake and outcomes from a large UK outpatient HIV service

OBJECTIVES: Bone health is negatively affected in people with HIV, and the risks of osteoporosis and fragility fractures are increased. The objective of this study was to describe the characteristics of those accessing bone health screening and identify factors associated with osteoporosis. METHODS: Retrospective data were collected from people accessing a large HIV outpatient service between September 2003 and December 2024. Inclusion criteria were age ≥ 60 years. Data were obtained from medical records, including patient demographics and clinical variables. The three most recent Dual Energy X-ray Absorptiometry (DEXA) scans were analysed. Descriptive statistics were used to summarise patient characteristics, and logistic regression was used to identify factors associated with the development of osteoporosis. RESULTS: Five hundred eighty-eight people (90.1% male, 91% white, 81% Men who have sex with Men, median age 67 years) were analysed. Of these, 79.6% (n = 468) had at least one DEXA scan. The prevalence of osteopenia and osteoporosis was 52% (n = 306) and 18% (n = 106), respectively. Of those with osteopenia at baseline who had DEXA data available, 11.1% (n = 34) progressed to osteoporosis. Only 29% (n = 31) of individuals with osteoporosis were receiving bisphosphonate therapy. Prolonged duration on anti-retroviral therapy, fractures and low lumbar spine T-scores were risk factors for developing osteoporosis during follow-up (p < 0.05). CONCLUSIONS: Bone health screening uptake was high in this cohort of older people with HIV, but management of established osteoporosis remained suboptimal. Previous fractures and low lumbar spine T-scores identified those at greater risk of progression to osteoporosis.