Introduction: Osteoporosis is among the chronic problems emerging as the human immunodeficiency virus (HIV)-positive population ages.
Sources of data: We reviewed the English language bibliography using Pubmed 2.0, Web of Science and Embase for relevant abstracts and articles.
Areas of agreement: The prevalence of low bone mineral density (BMD) and fracture is increased in the HIV-positive population.
Areas of controversy: The pathogenesis is multifactorial; there is some evidence that HIV infection is an independent risk factor and that highly active antiretroviral therapy has adverse skeletal effects.
Growing points: Physicians should routinely review the bone health of all HIV patients.
Areas timely for developing research: More studies of the mechanisms of bone loss, the skeletal effects of antiretroviral therapy and the therapeutic outcome of bone-protective therapy in HIV-positive individuals are needed.