Accelerated bone mineral loss in HIV-infected patients receiving potent antiretroviral therapy

Tebas, Pablo; Powderly, William G.; Claxton, Sherry; Marin, Donna; Tantisiriwat, Woraphot; Teitelbaum, Steven L.; Yarasheski, Kevin E.

doi:10.1097/00002030-200003100-00005

Cited by 484 publications

(283 citation statements)

References 22 publications

(19 reference statements)

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“…In the literature, several studies have discussed a possible relation between HAART [27,28,32,33], especially PIs [16,31,36,[39][40][41], and the occurrence of osteoporosis. Some studies suggest a role for indinavir in the occurrence of osteoporosis [30].…”

Section: Discussionmentioning

confidence: 99%

“…It has also been suggested that bone loss could be the consequence of HIV infection itself [7,11,24,25]. Several authors have proposed that alterations in bone mineral content and density are related to antiretroviral therapy [8,[26][27][28][29][30][31][32][33], but the evidence is still limited. To estimate the incidence of bone disorders in HIV-infected patients and to describe cases, we retrospectively investigated the Aquitaine cohort of 2700 patients derived from a hospital-based surveillance system of HIV infection set up in south-west France by the Groupe d'Epidémiologie Clinique du SIDA en Aquitaine (GECSA) [34].…”

Section: Introductionmentioning

confidence: 99%

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Symptomatic bone disorders in HIV‐infected patients: incidence in the Aquitaine cohort (1999–2002)

et al. 2004

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Background Since the inception of highly active antiretroviral therapy (HAART), mortality among HIV‐infected patients has decreased, but this has been accompanied by the appearance of several complications. Objectives To estimate the incidence of symptomatic bone disorders in HIV‐infected patients of the Aquitaine cohort (from south‐west France) for the period 1999–2002, and to describe cases. Methods We retrospectively studied the records of 2700 patients of the Aquitaine cohort, which was derived from a hospital‐based surveillance system of HIV infection in France. All cases of symptomatic bone disorders diagnosed from 1 January 1999 to 30 June 2002 were reviewed. Results Fourteen cases of bone disorders were diagnosed, eight cases of aseptic osteonecrosis and six cases of severe osteoporosis, representing incidences of 0.3/1000 patient‐years [95% confidence interval (CI): 0.14–0.62] and 0.22/1000 patient‐years (95% CI: 0.09–0.52), respectively. All patients with aseptic osteonecrosis were male, while all but one with osteoporosis were female. The ages of patients ranged from 36 to 54 years for osteonecrosis and from 39 to 50 for severe osteoporosis. At the time of clinical diagnosis, all patients were treated with nucleoside reverse transcriptase inhibitors (duration of treatment ranging from 19 to 123 months for osteonecrosis and from 46 to 132 months for severe osteoporosis). Ten patients were treated with nonnucleoside reverse transcriptase inhibitors [duration of treatment ranging from 6 to 31 months for osteonecrosis (n=6) and from 4 to 29 months for severe osteoporosis (n=4)]. Thirteen patients were treated with protease inhibitors [duration of treatment ranging from 12 to 62 months for osteonecrosis (n=8) and from 3 to 44 months for severe osteoporosis (n=5)]. All osteonecrosis and five osteoporosis patients had at least one known risk factor or comorbidity associated with the bone disorder occurrence. Conclusions In our study, the aetiology of clinical bone disorders seemed to be multifactorial, as almost all the patients had at least one possible risk factor in addition to HAART exposure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Symptomatic bone disorders in HIV‐infected patients: incidence in the Aquitaine cohort (1999–2002)

et al. 2004

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“…Several crosssectional studies have reported lower mean BMD in HIV-infected, antiretroviral therapy (ART)-experienced and ART-naïve men in comparison with age-matched HIV-negative controls [13][14][15][16]. Fewer studies have focused upon women.…”

Section: Introductionmentioning

confidence: 99%

Bone mass and mineral metabolism in HIV+ postmenopausal women

et al. 2005

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The objective of this cross-sectional study was to estimate the prevalence of and risk factors for osteoporosis in HIV+ postmenopausal women. Bone mineral density (BMD) by dual energy X-ray absorptiometry (DXA) and biochemical indices of mineral metabolism were measured in 31 Hispanic and African American HIV+ postmenopausal women. BMD was compared with 186 historical controls, matched for age, ethnicity and postmenopausal status. Mean BMD was significantly lower at the lumbar spine and total hip in the HIV+ group, as compared with controls. Prevalence of osteoporosis was higher in the HIV+ group than controls at the lumbar spine (42% vs 23%, p=0.03) and total hip (10% vs 1%, p=0.003). Among HIV+ women, time since menopause and weight were significant predictors of BMD, while duration or class of

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“…All this evidence is showing that bone deterioration in HIV is probably the result of the addition of traditional risk factors such as smoking, alcohol use, hypogonadism, low body weight, vitamin D deficiency, and factors directly related to HIV infection (24,29). However, the question in the late 2000's was if that decreased bone mass induced an excess risk of bone fractures.…”

Section: Hiv and Fracturesmentioning

confidence: 99%

HIV infection, bone metabolism, and fractures

Güerri‐Fernández

Villar-García

Díez-Pérez

et al. 2014

Arq Bras Endocrinol Metab

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With the advent of high active antiretroviral therapy there was a significant improvement on HIV subjects survival. Thus, bone changes related to HIV became an important aspect of these individuals. HIV affects bone remodeling causing bone fragility. In addition, antiretroviral therapy may also negatively affect bone metabolism. Several studies describe an increased incidence of fractures in these patients when compared with controls without the disease. The European Society of AIDS (EACS), and other societies, have included guidance on management of osteoporosis in HIV-infected patients emphasizing the identification of patients with low bone mass. Supplementation of calcium and vitamin D and the use of alendronate in these individuals should be recommended on a case base. RESUMOCom o advento da terapia antirretroviral, houve uma melhora considerável na sobrevida dos indivíduos portadores do vírus HIV. Dessa forma, as alterações ósseas referentes ao HIV se tornaram um fator importante no cuidado desses indivíduos. O HIV altera o remodelamento ósseo causando fragilidade óssea. As alterações causadas por esse vírus nos linfócitos T afetam a produção de RANKL e de citocinas pró-inflamatórias levando à osteoclastogênese. Ademais, a terapia antirretroviral também pode afetar negativamente o metabolismo ósseo. Vários estudos descrevem aumento da incidência de fraturas nesses indivíduos quando comparados a controles sem a doença. Diretrizes da Sociedade Europeia de SIDA (EACS) têm orientado o manejo da osteoporose nesses sujeitos, enfatizando a identificação de pacientes com baixa massa óssea. A suplementação de cálcio e vitamina D e o uso de alendronato nesses indiví-duos devem ser recomendados caso a caso. Arq Bras Endocrinol Metab. 2014;58(5):478-83 Descritores Osso; metabolismo ósseo; HIV; fraturas ósseas

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Accelerated bone mineral loss in HIV-infected patients receiving potent antiretroviral therapy

Abstract: Osteopenia and osteoporosis are unique metabolic complications associated with protease inhibitor-containing potent antiretroviral regimens, that appear to be independent of adipose tissue maldistribution.

Cited by 484 publications

References 22 publications

Symptomatic bone disorders in HIV‐infected patients: incidence in the Aquitaine cohort (1999–2002)

Symptomatic bone disorders in HIV‐infected patients: incidence in the Aquitaine cohort (1999–2002)

Bone mass and mineral metabolism in HIV+ postmenopausal women

HIV infection, bone metabolism, and fractures

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