Treatment
Options for Osteopenia and Osteoporosis in HIV Patients
The
purpose of the current study, published in the Annals of Pharmacotherapy
(April 15, 2008), was to review clinical data on drugs that may be considered
for use in the treatment of osteopenia (reduced bone density) and osteoporosis
(more severe bone loss) in HIV patients. Osteoporosis
in HIV patients is at least as prevalent as in postmenopausal women, yet this
population is not listed in primary care guidelines as one that should be considered
for bone screening. Conducted
at the Kansas City University of Medicine and Biosciences, this retrospective
analysis utilized a literature search and abstracts from major HIV conferences
between February 2001 and October 2007. Additional articles were retrieved from
citations of selected references. Relevant
information on the pharmacology, pharmacokinetics, safety, and efficacy of available
treatment for bone loss with hormonal and non-hormonal agents was selected. Greater
emphasis was placed on randomized clinical trials than on retrospective studies.
In addition
to bisphosphonates such as alendronate (Fosamax), other agents used to treat bone
disorders include calcitonin, raloxifene (Evista), and teriparatide (Forteo).
Often these are combined with vitamin D and calcium supplements. Three clinical
trials to date have evaluated the use of bisphosphonate for bone loss in HIV-infected
individuals. Results
•
The trials
showed a marked increase in bone mineral density in patients taking alendronate
versus those in the control groups (with/without calcium, vitamin D, and/or exercise
in one or both arms).
•
Dosing restrictions
complicate the use of these agents.
•
Dietary changes,
exercise, and calcium supplementation remain the foremost recommended strategies
to prevent or manage bone loss in people with HIV.
•
The use of
estrogen, testosterone, calcitonin, and teriparatide is less studied in HIV-positive
patients, but may be considered in select cases.
•
There are some
investigational agents not available in the U.S., but there are not enough data
available to support their use.
Conclusion In
conclusion, the study authors wrote, "Alendronate appears to be a promising
treatment option for HIV-infected patients with osteoporosis and osteopenia." "Further
research is required to determine the safety and efficacy of other available drugs,"
they added. "Until additional information is provided, and with available
knowledge on the metabolism profiles of antiretroviral and bone ossification agents,
alendronate appears to be the preferred agent to use in this population." Dybedal
Center for Clinical Research, Kansas City University of Medicine and Biosciences;
Adjunct Associate Professor, School of Pharmacy, University of Missouri-Kansas
City, Kansas City, MO. 5/02/08 Reference
PG Clay,
LE Voss, C Williams, and EC Daume. Valid Treatment Options for Osteoporosis and
Osteopenia in HIV-Infected Persons. Annals of Pharmacotherapy. April 15,
2008 [Epub ahead of print]. Related
Articles
D
Lin and MJ Rieder. Interventions for the treatment of decreased bone mineral density
associated with HIV infection. Cochrane Database Systematic Review.
April 18, 2007.
M
Stevenson, ML Jones, E De Nigris, and others. A systematic review and economic
evaluation of alendronate, etidronate, risedronate, raloxifene and teriparatide
for the prevention and treatment of postmenopausal osteoporosis. Health
Technology Assessment 9(22): 1-160. June 2005.
KA
Cappuzzo and JC Delafuente. Teriparatide for severe osteoporosis.
Annals
of Pharmacotherapy 38(2): 294-302. February 2004. | 
