Once-weekly Alendronate Reverses HIV-related Osteoporosis

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An unexpected higher incidence of osteopenia and osteoporosis has been reported in both treatment-experienced and treatment-naïve HIV positive individuals compared with the HIV negative population. The incidence and mechanism of this disorder are not yet clearly understood, but it is associated with severe clinical complications such as spontaneous vertebral or hip fracture.

Osteopenia and osteoporosis increase the risk of suffering pathological bone fractures twofold and fourfold, respectively. The treatment options for osteoporosis in HIV patients are also still unclear.

Alendronate (alendronic acid) is a nitrogen-containing biphosphonate that binds to bone surfaces and inhibits bone resorption. Oral alendronate has been shown to significantly increase bone mineral density (BMD), reduce the risk of vertebral and hip fractures in women, in men with primary osteoporosis, and osteoporosis caused by corticosteroid use.

In order to test the efficacy and safety of alendronate in the management of osteoporosis in anti-HIV treatment-experienced patients, researchers conducted a pilot study in HIV patients using stable protease-inhibitor- or non-nucleoside reverse transcriptase inhibitor-including HAART.

Osteoporosis was defined as a BMD t-score of 2.5 or less in the lumbar spine, hip or trochanter. Any other cause of secondary osteoporosis excluded patients from the study.

Participants were randomly assigned to receive oral alendronate, 70 mg once a week plus dietary counseling (n = 11) or to dietary counseling alone (n = 14) (control group). Alendronate was administered with tap water, at least 30 min before breakfast. All patients continued their HAART treatment.

Patients were followed every 24 weeks for a total of 96 weeks.

At week 96, 27% of patients on alendronate versus 96% of controls presented with osteoporosis. Spine bone mineral density (BMD) increases were detected at week 48, and progressed thereafter.

Improvements in trochanter BMD were obtained after 2 years.

The authors conclude, “Once-weekly oral alendronate may be an effective and safe treatment for HIV-1-associated osteoporosis.”

Lluita contra la SIDA Foundation Clinical Nutrition Unit Rheumatology Internal Medicine, Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain CETIR Centre Medic, Barcelona, Spain.

03/30/05

Reference
E Negredo and others. Reversal of HIV-1-associated osteoporosis with once-weekly alendronate. AIDS 19(3):343-345. February 18, 2005.