Denosumab for the treatment of HIV-associated osteoporosis with fractures in a premenopausal woman

Marasco, Emiliano; Mussa, Marco; Motta, Francesca; Bobbio-Pallavicini, Francesca; Maserati, Renato; Montecucco, Carlomaurizio; Bogliolo, Laura

doi:10.4081/reumatismo.2021.1358

Cited by 8 publications

(3 citation statements)

References 17 publications

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“…Experts from the HIV consensus proposal ( 31 ) recommend that patients at a high risk of fracture (brittle fracture, osteoporosis, bone loss, or an elevated FRAX score) avoid using nucleotide reverse transcriptase inhibitors and protease inhibitors and instead implement diet and lifestyle management strategies such as calcium supplementation (500–600 mg/day), cholecalciferol (800–1200 IU/day), and anti-osteoporosis therapy. Although bisphosphonates can reportedly improve BMD ( 32 , 33 ), the use of teriparatide ( 34 ) and denosumab ( 35 ) has only been reported in a few cases.…”

Section: Discussionmentioning

confidence: 99%

Tenofovir-induced osteopenia and hyperparathyroidism: A case report and literature review

Zeng

Wang

et al. 2023

Front. Endocrinol.

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Tenofovir disoproxil fumarate is the first-line antiviral therapy for chronic viral hepatitis B, but long-term use is associated with renal failure and hypophosphatemic osteomalacia. Tenofovir disoproxil fumarate-induced osteoporosis and secondary hyperparathyroidism are less commonly reported. Herein, we describe the case of a patient with bone and multijoint pain who was initially misdiagnosed as having normocalcemic primary hyperparathyroidism associated with prolonged exposure to tenofovir disoproxil fumarate. The patient’s 24-h urinary calcium and phosphorus excretion levels and serum calcium levels were at the lower end of the normal range. After reviewing these findings, the diagnosis was amended to osteoporosis and secondary hyperparathyroidism caused by tenofovir disoproxil fumarate. In this report, we describe the differences in clinical and laboratory manifestations of hyperparathyroidism induced by tenofovir disoproxil fumarate and normocalcemic primary hyperparathyroidism. We also discuss relevant pathophysiological mechanisms and propose a feasible treatment strategy.

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Section: Discussionmentioning

confidence: 99%

Tenofovir-induced osteopenia and hyperparathyroidism: A case report and literature review

Zeng

Wang

et al. 2023

Front. Endocrinol.

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“…In a case report of a 38-year-old woman living with HIV, denosumab treatment given for 4 years was associated with an increase in BMD and a decrease in bone fracture without reactivation of opportunistic infection or HIV infection [ 113 ]. Wheeler et al showed in a case report that Teriparatide is safe and effective for the treatment of osteoporosis in PLWHIV [ 114 ].…”

Section: Anti-osteoporotic Drugsmentioning

confidence: 99%

Bone Health in People Living with HIV/AIDS: An Update of Where We Are and Potential Future Strategies

et al. 2023

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The developments in Human Immunodeficiency Virus (HIV) treatment and in the care of people living with HIV (PLWHIV) and Acquired Immunodeficiency Syndrome (AIDS) over the last three decades has led to a significant increase in life expectancy, on par with HIV-negative individuals. Aside from the fact that bone fractures tend to occur 10 years earlier than in HIV-negative individuals, HIV is, per se, an independent risk factor for bone fractures. A few available antiretroviral therapies (ARVs) are also linked with osteoporosis, particularly those involving tenofovir disoproxil fumarate (TDF). HIV and hepatitis C (HCV) coinfection is associated with a greater risk of osteoporosis and fracture than HIV monoinfection. Both the Fracture Risk Assessment Tool (FRAX) and measurement of bone mineral density (BMD) via a DEXA scan are routinely used in the assessment of fracture risk in individuals living with HIV, as bone loss is thought to start between the ages of 40 and 50 years old. The main treatment for established osteoporosis involves bisphosphonates. Supplementation with calcium and vitamin D is part of clinical practice of most HIV centers globally. Further research is needed to assess (i) the cut-off age for assessment of osteoporosis, (ii) the utility of anti-osteoporotic agents in PLWHIV and (iii) how concomitant viral infections and COVID-19 in PLWHIV can increase risk of osteoporosis.

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“…Additionally, single case report of prolonged denosumab in a premenopausal WLWH found it to be safe and effective [93]. However, a rebound phenomenon on discontinuation, with a three‐ to five‐fold increased risk for some fractures, has been observed in the general population[94] and so caution should be taken in prescribing. This risk/benefit is more of a consideration in younger patients, which has particular relevance for PLWH.…”

Section: Clinical Guidance For Bone Health Screening and Interventionmentioning

confidence: 99%

HIV and fracture: Risk, assessment and intervention

McGee,

Cotter

2023

HIV Medicine

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ObjectivesWith management of comorbidity in people living with HIV (PLWH) a key component of clinical care, early loss of bone integrity and clinical fracture are recognized as important issues. This review aims to describe the epidemiology of fracture in PLWH, as well as summarizing the relative balance of factors that contribute to fracture. We also aim to describe fracture risk assessment and interventional strategies to modify the risk of fracture in this population.ResultsData from recent meta‐analyses show that PLWH have significantly more fractures than the general population, with men and injecting drug users at higher risk. Modifiable factors that contribute to fracture risk in this cohort include body mass index (BMI), drug use, concurrent medications, frailty, and hepatitis C virus infection. Relating to antiretroviral therapy, current or ever tenofovir exposure has been identified as predictive of fracture but not cumulative use, and a potentially modest protective effect of efavirenz has been observed. Fracture Risk Assessment Tool scores underestimate fracture risk in PLWH with improved accuracy when HIV is considered a cause of secondary osteoporosis and bone mineral density (BMD) included.ConclusionEarly consideration of risk, prompting evaluation of modifiable risk factors, frailty and falls risk with bone density imaging and prompt intervention may avert fracture in PLWH. Guidance on screening and lifestyle modification is available in international guidelines. Bisphosphonates are safe and effective in PLWH, with limited data for other agents.

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Denosumab for the treatment of HIV-associated osteoporosis with fractures in a premenopausal woman

Cited by 8 publications

References 17 publications

Tenofovir-induced osteopenia and hyperparathyroidism: A case report and literature review

Tenofovir-induced osteopenia and hyperparathyroidism: A case report and literature review

Bone Health in People Living with HIV/AIDS: An Update of Where We Are and Potential Future Strategies

HIV and fracture: Risk, assessment and intervention

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