It is defined as a BMD T-score of ≤ –2.5, i.e. ≥ 2.5 standard deviations below the mean value for a healthy gender-matched individual at peak bone mass [23]. Low BMD is a major risk factor for fragility fracture. In the general population, risk factors for fractures include increasing age, low BMI, female gender, family history of hip fracture, vitamin D deficiency, excessive alcohol

intake, current smoking, lack of physical activity, and exposure to certain drugs, for example long-term glucocorticoid click here usage [24]. Approximately 3 million people in the UK have osteoporosis, and each year there are over 230 000 fragility fractures. In the general population, age-related bone loss starts around the age of 40 years and continues throughout life, resulting in an age-related increase in the incidence of fragility fractures. As the median life expectancy increases, the number of fractures is expected to rise significantly. Between 1990 and 2000, the incidence of hip fractures in the developed world increased CYC202 by approximately 25% [25]; it has been projected that, by 2050, the incidence of hip fractures world-wide will have increased by 310% and 240% in men and women, respectively [26]. There is, at present, no national screening programme

for osteoporosis in the UK. The disease is diagnosed on the basis of dual energy X-ray absorptiometry (DXA) scanning in people considered to be at increased risk, principally post-menopausal women. However, the WHO has developed a 10-year fracture prediction tool (FRAX) for use in people aged between 40 and 90 years (www.shef.ac.uk/FRAX/). This 12-item tool was developed from population-based cohorts from Europe, North America, Asia and Australia, and integrates clinical risk factors with BMD at the femoral neck. FRAX generates the 10-year probability of hip fracture D-malate dehydrogenase and major osteoporotic fracture (hip, spine, wrist or humerus), and can be used with or without BMD. Of note, falls are an important risk factor for nonvertebral

fractures, but are not included in the FRAX algorithm. Current approaches to managing metabolic complications in HIV-infected individuals are included in guidelines from the British HIV Association (BHIVA) [27], and the latest European AIDS Clinical Society (EACS) guidelines in a section on noninfectious comorbidities [28]. These generally focus on identifying patients with specific diseases, such as diabetes and kidney disease, and those with risk factors for diseases such as CVD. The BHIVA guidelines recommend lipid analysis [total cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides] at baseline, yearly, and before and after treatment or targeted intervention, or more frequently if a high CHD risk dictates.