Authors
David Vladut Razvan, Ovidiu Rosca, Felix Bratosin, Vlad Predescu, Silviu Valentin Vlad, Adrian Vlad
Published in
Journal of clinical medicine. Volume 14. Issue 21. Oct 29, 2025. Epub Oct 29, 2025.
Abstract
Background and Objectives: People living with HIV (PLWH) have excess fragility fractures not fully explained by areal DXA. We reviewed bone "quality" in PLWH-microarchitecture, estimated strength, tissue-level properties-and vertebral fractures (VFs). Methods: PRISMA-conform systematic review (2000-2025) of randomized, cohort, and cross-sectional studies assessing HR-pQCT (±finite-element analysis), trabecular bone score (TBS), impact microindentation (BMSi), femoral QCT/MRI, and VF imaging (DXA-VFA or radiography). Risk of bias used ROBINS-I (non-randomized) and RoB 2 (randomized/switch). No meta-analysis was performed due to clinical/methodological heterogeneity; evidence was synthesized narratively per SWiM. Results: Fourteen studies met criteria. HR-pQCT showed cortical/trabecular deficits with lower finite-element-estimated strength in PLWH. BMSi was 3-4 units lower; it declined after ART initiation but improved after TDF→TAF switch. TBS was modestly lower and reclassified risk when BMD was non-osteoporotic. VF prevalence was 12-25% and frequently occurred at non-osteoporotic BMD. Signals aligned with modifiable risks (smoking, glucocorticoids) and specific ART exposures. Conclusions: Beyond DXA, PLWH exhibit quantifiable decrements in microarchitecture, estimated strength, and tissue-level properties alongside a meaningful VF burden. TBS and VFA are pragmatic, scalable adjuncts to refine risk; HR-pQCT/BMSi add mechanistic value in research/tertiary settings. Prospective studies linking these metrics to incident fractures are warranted.
PMID:
41227065
Bibliographic data and abstract were imported from PubMed on 11 Dec 2025.
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