As low vitamin D levels are near universal in winter in HIV-infected patients living in the UK, there is little to be gained from routine vitamin D testing. The best method to detect low bone

mass is hip and lumbar spine DXA scanning. The usefulness of biomarkers to identify patients with (or at increased risk of) osteoporosis and fragility fractures remains to be established. Although bone densities are lower than expected based on age (see MG-132 mw above), severe osteoporosis and nontraumatic (fragility) bone fractures in this population remain uncommon. The data on whether HIV-infected individuals are at increased risk of fragility fracture compared with the general population are conflicting [[44], 45]. Therefore, routine BMD

measurement is not recommended for all patients with HIV infection. Scoring systems that incorporate age, BMI, BMD, gender and other risk factors have been developed and allow assessment of the risk of fractures and the need for treatment [e.g. FRAX WHO Fracture Risk Assessment Tool (www.shef.ac.uk/FRAX)]. The National Osteoporosis Guidelines Group (NOGG) has devised a management flow chart for patients stratified by Ku-0059436 order fracture risk [high, intermediate and low (www.shef.ac.uk/NOGG)]. It is recommended that, in addition to risk assessment, women 65 years and older and men 70 years and over should routinely have BMD assessed (usually by DXA scan). Furthermore, in view of the high prevalence of low bone density in HIV-infected patients, BMD assessment should be considered in patients aged 50 years and over if intermediate- or high-risk stratification by FRAX or additional risk factors for low bone mass or fracture are present (HIV or related risk factors, including increased duration of HIV infection, low nadir CD4 T-cell count and hepatitis virus coinfection). As a consequence of the lack of consistent data on fragility fracture risk and also the potential cost implication of DXA scanning, there is no recommendation for routine screening in patients below 50 years of age. Risk factors for reduced bone mineral density should be assessed at first HIV

diagnosis and prior to ART commencement. Risk factors should be further assessed in individuals on ART and 50 years or older every 3 years (IV). Bone mineral Chlormezanone density (BMD) assessment (usually by DXA) should be performed in all men aged 70 years and older and all women aged 65 years and older. Consider BMD assessment in men and women over 50 years old if they have an intermediate to high FRAX score and/or additional risk factors. Anaemia, neutropenia and thrombocytopenia are common in patients with advanced immunosuppression and severe (opportunistic) infections or malignancy. By contrast, abnormalities on full blood count (FBC) are relatively uncommon in ART-naïve individuals with CD4 T-cell counts over 350 cells/μL.