Bisphosphonates, a safe and effective treatment for HIV-associated osteopenia

Bisphosphonates with vitamin D and calcium, represent a safe and effective treatment of osteopenia in HIV-positive patients for the AIDS virus (HIV +), using a prospective randomized study published in American magazine "JAIDS".

Thirty-one HIV-infected patients with osteopenia or osteoporosis and on highly active antiretroviral therapy (HAART) were treated for 11 months with calcium supplementation (1.000mg/jour calcium carbonate) and vitamin D (400 IU / day) . "This is the minimum standard of treatment for patients with low bone mineral density (BMD)," say the authors, Kristin Mondy at Washington University School of Medicine and colleagues.

In addition to the minimum treatment, 15 patients received bisphosphonate due to 70mg/semaine.

A significant difference was observed in the lumbar spine BMD after 11 months, regardless of the initial degree of osteopenia / osteoporosis, the authors report.

The change in lumbar spine BMD was 5.2% in the bisphosphonate group against 1.5% in the calcium + vitamin D alone group. The difference becomes significant at 6 months, the researchers said.

The differences in BMD appear less significant at other anatomical levels, particularly at the hip or total skeleton. "It is in the lumbar spine that bisphosphonates produce more marked early effects. Longer and larger study is needed to verify a possible effect on other sites," they comment.

Bisphosphonates do not appear to cause interactions with various HIV-related treatment, including nucleoside and non-nucleoside reverse transcriptase inhibitors or protease.

"This study shows that treatment with bisphosphonate is effective regardless of the age of the HIV infection, duration or type of HAART," the authors conclude.

However, it "should not be construed as a recommendation of treatment for all HIV + patients with osteopenia," do they specify. "In the absence of larger trials, the recommendations should be aligned with national or international standard recommendations."

Osteopenia is one of the most common metabolic complications associated with HIV, remember Dr. Mondy and colleagues. Prevalence reached 28% in HIV + patients naive and 40% to 50% among those who received antiretrovirals.

Although we do not know the mechanisms involved in the accelerated loss of BMD in HIV + patients, it seems that some associated factors (such as poor diet) play an important role. In fact, most patients who have completed the "standard treatment" had their BMD increase, although this change did not reach a significant level.

"It seems highly advisable to doctors after HIV patients with osteopenia / osteoporosis declared assess nutritional factors and potentially reversible causes of osteopenia when considering further treatment," say the authors.