Patients with human immunodeficiency virus (HIV) infection have a higher risk of low bone mineral density (BMD) and fragility fracture than the general population, although the etiological mechanisms are poorly known. The aim of this review is to summarize the available literature data about alterations of bone metabolism in HIV-infected patients to assess the impact of HIV infection and highly active antiretroviral therapy (HAART) on the risk of developing osteopenia and osteoporosis and to provide guidance on the screening, diagnosis, and monitoring of bone disease in HIV-positive population.