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Efficacy of long-term osteopenia/osteoporosis treatment in the Slovene HIV-infected male population

DOI: 10.7448/ias.15.6.18326

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Abstract:

Purpose of study: In our study from 2006, high prevalence of reduced bone mineral density (BMD) among Slovene HIV-infected male population was observed. The aim of the present study was to evaluate bone status six years after treatment intervention. Methods: 69 HIV-infected male patients (out of 96, studied in 2006) were assessed for change in BMD using dual X-ray absorptiometry and markers of bone turnover. The effects of HIV-associated factors (time since infection, ART duration, viral load, CD4+count), changes in life-style risk factors (smoking, physical activity, alcohol consumption, amount of milk in diet) and treatment of osteopenia/osteoporosis were assessed. Therapy for osteopenia/osteoporosis was used in 30 patients; vitamin D and calcium supplementation in 20 patients with osteopenia and additionally bisphophonates in 15 patients with osteoporosis or androgens in case of hypogonadism, respectively. 39 patients were not treated. Summary of results: Therapy of osteopenia/osteoporosis maintained BMD values in 18 (66.7%) patients, as compared to only 8 (25%) patients without therapy (p=0.002). Lumbar spine BMD increased by 4.1% during the 6-year period for patients with therapy, as compared with an increase of 0.9% for patients without therapy (p=0.033). The difference in total hip values was even more significant, with a 2.6% increase in BMD with therapy, compared to a 1.95% decrease without therapy (p<0.0001). Some increase in the physical activity and milk consumption among HIV-infected population was observed, while the smoking rate and alcohol consumption remained the same. Risk-factors associated with life-style did not have any effect on BMD change. According to the logistic regression model, long-term vitamin D and calcium supplementation was the most significant factor associated with maintaining BMD values (p=0.010; OR= 14.4). Conclusions: Long-term treatment, especially with vitamin D and calcium, was safe and efficient in the treatment of osteopenia/osteoporosis in HIV infected patients. As BMD values decreased in a majority of individuals without therapy, and given the absence of any association between life-style change and BMD improvement, early vitamin D and calcium supplementation in the HIV-infected population is required.

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