A meta-analysis on the prevalence of reduced bone mineral density (BMD) in human immunodeficiency virus (HIV)-infected individuals was conducted in 2006. Since then, an additional 13 cross-sectional and 6 longitudinal studies have been published. Hence, our aim was to systematically review published literature on the prevalence of reduced BMD and its associated risk factors in HIV-infected individuals. A literature search was conducted from 1989-2015 in six databases. Full text, English articles on HIV-infected individuals ≥18 years, which used dual X-ray absorptiometry (DXA) to measure BMD were included. Studies were excluded if the prevalence of osteopenia/osteoporosis were without a comparison group, and BMD or T-score were not reported. Twenty-one cross-sectional and eight longitudinal studies were included. The prevalence of reduced BMD was significantly higher in both HIV-infected [odds ratio=3.2(95%Cl 2.0,5.0)] and ART-treated individuals [odds ratio=2.4(95%Cl 1.3,4.2] when compared to controls. PI-treated individuals had an odds ratio of 1.3(95%Cl 0.9,1.9) of reduced BMD compared to controls, whilst a higher proportion of tenofovir-treated individuals (52.6%) had lower BMD compared to controls (42.7%), but these results were not statistically significant (p=0.248). No significant difference in the percent change of BMD at the lumbar spine, femoral neck or total hip from baseline to follow-up at 14-33 months was found between HIV-infected, PI-treated, tenofovir-treated versus their controls, respectively. Older age, history of bone fracture, low BMI, low body weight, ethnicity, low testosterone level, smoking, low CD4 cell count, lipodystrophy, low fat mass and lean mass were found to be associated with low BMD. In conclusion, we found that short term accelerated BMD loss occurred within the first 14 months of HIV infection and ART initiation, but BMD loss stabilized thereafter. Hence, the monitoring of HIV-infected individuals for osteoporosis should be performed during the first year of HIV infection and ART initiation, regardless of age or gender.