Poster Presentation 1st Asia Pacific Herbert Fleisch Workshop 2025

Menopause-related bone loss in women living with HIV: A systematic review (#115)

Denekew Tenaw Anley 1 , Celine Camon 2 , Jakub Mesinovic 1 , Florence Nabwire 3 4 , Mystica Jude 1 , Isatou Drammeh 5 , Kate A Ward 5 6 , Celia L Gregson 7 8 , Peter R Ebeling 1 , Mícheál Ó Breasail 1
  1. Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Monash Medical Centre, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
  2. Centre for Neuroendocrinology, Department of Anatomy, University of Otago, , Dunedin, New Zealand
  3. MRC Epidemiology Unit, University of Cambridge, Level 3 Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SL, UK
  4. Institute for Sustainability Leadership, University of Cambridge, Entopia Building, 1 Regent Street, Cambridge CB2 1GG, UK
  5. MRC Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
  6. MRC Lifecourse Epidemiology Centre, Human Development and Health, University of Southampton, , Southampton, UK
  7. Global Musculoskeletal Research Group, Musculoskeletal Research Unit, Bristol Medical School, Bristol, UK
  8. The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe

Background: Improved life expectancy due to antiretroviral therapy (ART) means women living with HIV (WLH) are increasingly at risk of age-related diseases such as osteoporosis. While HIV and its treatment can negatively impact bone health, data from WLH across menopause, when bone losses are already high, are limited.

Methods: We systematically searched five electronic databases (MEDLINE, Embase, Global Health, Scopus, and Web of Science) up to April 22, 2025, using a search strategy combining terms related to HIV, menopause, and bone measurements. Cross-sectional and longitudinal studies assessing bone measures in mid-life WLH, and their comparators without HIV, were included. Quality assessment was performed using the Joanna Briggs Institute Critical Appraisal tools.

Results: After deduplication, 1,057 articles were screened, with 17 records included following full-text review. The majority (9/17) were from North America, with the remainder from Africa (5/17) and South America (3/17). Dual-energy X-ray absorptiometry-based cross-sectional studies consistently found WLH had lower areal bone mineral density (aBMD) than peers without HIV at a similar menopause stage. Longitudinal studies also suggested that WLH experience greater menopause-related bone loss than those living without HIV. Computed Tomography-based studies (3/17) reported trabecular compartment-specific bone deficits in WLH, relative to women without HIV. Associations between ART use, particularly tenofovir disoproxil fumarate (TDF), and bone outcomes were conflicting, possibly driven by the ubiquity of TDF as a first-line therapy across Africa. Overall, study quality was high in most domains, though longitudinal studies suffered from incomplete follow-up (Figure).

Conclusion: This systematic review highlights that WLH have poorer bone-related outcomes, including lower BMD, during all stages of menopause transition, experience greater menopause-related bone losses, predominantly in trabecular-rich sites compared to women without HIV.  These findings highlight the need for context-specific targeted bone health assessment and management strategies for this underserved population with elevated fracture risk.

685e1b95bf17b-RoB+_final22222.png

Figure: Quality assessment of the included cross-sectional (A) and longitudinal (B) studies in the study of menopause related bone loss in WLH