Interventions for the treatment of decreased bone mineral density associated with HIV infection

Lin, Daren; Rieder, Michael J.

doi:10.1002/14651858.cd005645.pub2

Cited by 27 publications

(18 citation statements)

References 13 publications

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“…However, a recent systematic review drew attention to the lack of high-level evidence in the context of HIV infection, but indicated that bisphosphonates were safe alternatives to calcium and vitamin D in the HIV-positive population and could improve the BMD. 42 Alendronate has been identified as the drug of choice in this setting, being relatively well tolerated because it can be administered weekly. 43 However, in the small study populations analysed, extrapolation from improvements in the BMD to a reduced fracture risk was not performed.…”

Section: Reduced Bmd May Increase the Risk Of Fragility Fracture In Hmentioning

confidence: 99%

Fracture healing in HIV-positive populations

Richardson

Hill

Johnston

et al. 2008

The Journal of Bone and Joint Surgery. British volume

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Highly active anti-retroviral therapy has transformed HIV into a chronic disease with a long-term asymptomatic phase. As a result, emphasis is shifting to other effects of the virus, aside from immunosuppression and mortality. We have reviewed the current evidence for an association between HIV infection and poor fracture healing. The increased prevalence of osteoporosis and fragility fractures in HIV patients is well recognised. The suggestion that this may be purely as a result of highly active anti-retroviral therapy has been largely rejected. Apart from directly impeding cellular function in bone remodelling, HIV infection is known to cause derangement in the levels of those cytokines involved in fracture healing (particularly tumour necrosis factor-alpha) and appears to impair the blood supply of bone. Many other factors complicate this issue, including a reduced body mass index, suboptimal nutrition, the effects of anti-retroviral drugs and the avoidance of operative intervention because of high rates of wound infection. However, there are sound molecular and biochemical hypotheses for a direct relationship between HIV infection and impaired fracture healing, and the rewards for further knowledge in this area are extensive in terms of optimised fracture management, reduced patient morbidity and educated resource allocation. Further investigation in this area is overdue.

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Section: Reduced Bmd May Increase the Risk Of Fragility Fracture In Hmentioning

confidence: 99%

Fracture healing in HIV-positive populations

Richardson

Hill

Johnston

et al. 2008

The Journal of Bone and Joint Surgery. British volume

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“…This provides a 50% reduction in the incidence of vertebral, nonvertebral, and femoral fractures in non-HIV-positive osteoporotic patients. Although not extensively studied in PLWHIV, Lin and Rieder identified 3 open randomized studies showing that alendronate used in association with calcium and vitamin D had a beneficial effect on the BMD of osteopenic HIV-positive patients for 1 to 2 years, ie, similar to the results obtained in studies on postmenopausal osteoporosis 36. However, these studies only covered 2-year periods and the risk of fracture could not be observed.…”

Section: Osteoporosis Treatment For Plwhivmentioning

confidence: 81%

Osteopenia and osteoporosis in people living with HIV: multiprofessional approach

Lima¹

2011

HIV

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Increasing bone mineralization abnormalities observed among people living with HIV (PLWHIV) result from various factors relating to the host, the virus, and the antiretrovirals used. Today, HIV infection is considered to be a risk factor for bone mineralization disorders. The test most recommended for diagnosing osteoporosis is measurement of bone mineral density by means of dual energy X-ray absorptiometry at two sites. Osteoporosis treatment has the aims of bone mass improvement and fracture control. A combination of calcium and vitamin D supplementation may reduce the risk of fractures. Antiresorptive drugs act by blocking osteoclastic activity and reducing bone remodeling. On the other hand, bone-forming drugs stimulate osteoblastogenesis, thereby stimulating the formation of bone matrix. Mixed-action medications are those that are capable of both stimulating bone formation and inhibiting reabsorption. Antiresorptive drugs form the group of medications with the greatest quantity of scientific evidence confirming their efficacy in osteoporosis treatment. Physical activity is a health promotion strategy for the general population, but only preliminary data on its real value and benefit among PLWHIV are available, especially in relation to osteoporosis.

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“…27,28,46 Similar results have been observed with Testim ® as well as with other forms of TRT in men with HIV/AIDS. 29,33,34,49,50 Lean body mass and percent body fat were not among the parameters recorded in the TRiUS registry; however, other studies of Testim ® use in men with hypogonadism with limited additional health problems have shown improvements in lean body mass, fat mass, and percent body fat relative to baseline or compared with placebo-treated men. 27,28 The non-HIV/AIDS cohort in the TRiUS registry exhibited statistically significant reductions in BMI, body weight, and waist circumference, possibly because this cohort was obese (BMI $ 30 kg/m 2 ) at baseline, whereas the HIV/AIDS cohort was not.…”

Section: Discussionmentioning

confidence: 96%

Testosterone Replacement Therapy in Men With Hypogonadism and HIV/AIDS: Results From the TRiUS Registry

Blick¹,

Khera

Bhattacharya

et al. 2013

Postgraduate Medicine

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This 12-month, non-placebo-controlled, observational study of Testim® use in men with and without HIV/AIDS suggests that TRT may provide clinical benefits irrespective of the patient's HIV/AIDS status. This conclusion is supported by the higher testosterone levels, better sexual function, lower depression scores, and better body composition profiles found in both groups. However, given the loss of patients to follow-up, these results may reflect a bias toward drug responders.

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Interventions for the treatment of decreased bone mineral density associated with HIV infection

Cited by 27 publications

References 13 publications

Fracture healing in HIV-positive populations

Fracture healing in HIV-positive populations

Osteopenia and osteoporosis in people living with HIV: multiprofessional approach

Testosterone Replacement Therapy in Men With Hypogonadism and HIV/AIDS: Results From the TRiUS Registry

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