Letter to the Editor

Algorithm for the Management of Osteoporosis

Authors: Ana Lucia M. Lima, MD, PhD, Priscila R. Oliveira, MD, Riccardo G. Gobbi, MD, Alexandre L. Godoy-Santos, MD, Gilberto L. Camanho, MD, PhD

Abstract

To the Editor:


In their recent article, Hamdy et al1 propose an algorithm for the management of osteoporosis and recommend that patients at risk for osteoporosis should be tested with dual-energy X-ray absorptiometry (DXA) measurement of at least two skeletal sites. We agree with this recommendation, and we think that human immunodeficiency virus-(HIV) positive patients older than 49 years should be included in the group of at-risk patients to be tested. Recent studies show that the incidence of osteopenia and osteoporosis in this population is higher than in the HIV-negative population.2–4 We believe that current evidence supports the inclusion of HIV infection among other risk factors.5


Ana Lucia M. Lima, MD, PhD


Priscila R. Oliveira, MD


Riccardo G. Gobbi, MD


Alexandre L. Godoy-Santos, MD


Gilberto L. Camanho, MD, PhD


Department of Orthopaedics and Traumatology


University of Sao Paulo


Sao Paulo, Brazil




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References

1. Hamdy RC, Baim S, Broy SB, et al. Algorithm for the management of osteoporosis. South Med J 2010;103:1009–1015.
 
2. Stone B, Dockrell D, Bowman C, et al. HIV and bone disease. Arch Biochem Biophys 2010;503:66–77.
 
3. Sharma A, Flom PL, Weedon J, Klein RS. Prospective study of bone mineral density changes in aging men with or at risk for HIV infection. AIDS 2010;24:2337–2345.
 
4. Grijsen ML, Vrouenraets SM, Steingrover R, et al. High prevalence of reduced bone mineral density in primary HIV-1-infected men. AIDS 2010;24:2233–2238.
 
5. McComsey GA, Tebas P, Shane E, et al. Bone disease in HIV infection: a practical review and recommendations for HIV care providers. Clin Infect Dis 2010;51:937–946.