In HIV, BMD May Be Improved With Bisphosphonates

Bisphosphonate therapy may increase bone mineral density (BMD) among children and adolescents who are perinatally infected with HIV, according to new data.

Individuals with HIV and low BMD have a higher risk of osteoporosis and fractures later in life. And although bisphosphonate therapy is known to reduce the risk of fractures among adults, the safety and efficacy of bisphosphonate therapy have not been formally studied in youths.

To assess the safety and efficacy of bisphosphonate therapy, the researchers evaluated 52 individuals aged 11 to 24 years who were infected with HIV immediately before or after birth who had low lumbar spine BMD, as defined by a Z score of less than -1.5.

Participants were randomly assigned to a once-weekly alendronate group or a placebo group; all participants took daily calcium carbonate and vitamin D supplementation, as well as participated in weight-bearing exercise.

Safety and efficacy of treatment were assessed at weeks 48 and 96.

The researchers’ initial analysis showed that 16% of participants in the once-weekly alendronate group and 11% of participants in the placebo group had developed Grade 3 or higher abnormal laboratory values, signs, or symptoms.

Participants in the once-weekly alendronate group also had significantly higher mean increases in lumbar spine BMD than participants in the placebo group (20% vs 7%). Similar increases were found for whole body BMD as well.

“In this small study in children and adolescents perinatally infected with HIV with low [lumbar spine] BMD, 48 weeks of alendronate was well-tolerated, showed no safety concerns, and significantly improved [lumbar spine] and whole body BMD compared to participants on vitamin D/calcium supplementation and exercise alone,” the researchers concluded.

—Amanda Balbi

Reference:

Jacobson DL, Lindsey JC, Gordon C, et al. Alendronate improves bone mineral density in children and adolescents perinatally infected with human immunodeficiency virus with low bone mineral density for age. Clin Infect Dis. 2020;71(5):1281-1288. https://doi.org/10.1093/cid/ciz957