AEGiS-Glasgow [PL10.4] Is osteoporosis real? Pathogenesis and management

Seventh International Congress on Drug Therapy in HIV Infection

Glasgow, UK - 14-17 November 2004

[PL10.4] Is osteoporosis real? Pathogenesis and management

Int Cong Drug Therapy HIV 2004 Nov 14-18;7:Abstract No. PL10.4

William G. Powderly
University College Dublin, Dublin, Ireland

Bone disorders have emerged in the last five years as potentially an additional long-term complication of HIV infection and/or its treatment. Osteonecrosis, especially involving large joints, has been linked to the duration of antiretroviral therapy. Multiple studies suggest that HIV-infected patients receiving potent antiretroviral therapy have an increased prevalence of both osteopenia and osteoporosis, with rates of osteopenia ranging from 20-50%. Studies prior to the era of current antiretroviral therapy suggest that HIV infection has a modest effect on bone turnover, resulting in a mild decrease in bone mineral density; this is greater in patients with extensive weight loss. Treatment of HIV increases bone turnover with a greater effect on bone resorption initially. The mechanisms for increased bone demineralization in HIV infected patients are unclear, although there is some evidence that specific drugs may inhibit bone formation in vitro. Although, the decrease in bone mineralization is measurable, the clinical significance is much less clear. Several studies suggest that, in general, bone loss is not progressive over a relatively short periods of follow-up (up to 3 years), and as yet there have been no data indicating an increased fracture risk in HIV infected patients. Small clinical trials indicate that the bisphosphonates may be useful in management, if treatment is warranted; however, larger studies are needed to confirm these findings and assess the long-term implications of bone loss in HIV-infected persons.

SESSION 10: HEPATITIS CO-INFECTIONS AND ADVERSE EVENTS II

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2004-11-14
PL10.4

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