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• W2000619372 abstract "In this number, Pepe et al. are publishing a paper evaluating the effects of 1 year of risedronate treatment on bone mineral density (BMD) in HIV-infected patients with or without hypogonadism [1]. Their results show that also, risedronate is effective in the therapeutic management of osteoporosis in HIV, as well as alendronate and zoledronate. Subclinical vertebral fractures are common in HIVinfected persons with a prevalence that can be as high as 25 % and they should be considered a strong risk factor for future fractures [2, 3]. Anti-osteoporosis treatment should be initiated for HIVinfected patients on the basis of the same criteria as those used in general population [4, 5]. Therefore, all HIVinfected postmenopausal women and the seropositive men aged more than 50 years, at high risk for fracture, should be offered a therapy. However, as a matter of fact, many of these patients are young females and males and, as for the general population, a treatment threshold has yet to be established for HIV patients younger than 40 years. A more prudent approach must be followed in young HIV patients, but an anti-osteoporosis therapy should be considered in response to a fragility fracture [5]. Many drugs are available for the treatment of osteoporosis and their efficacy has always been established on the basis of their ability in reducing fracture risk. On the contrary, no trials have been done on the anti-fracture effects of these drugs in HIV. The ability of bisphosphonates in increasing BMD has been demonstrated in HIVpositive patients, while no data are available on the use of bone-forming agents (teriparatide and PTH 1-84). One of the first studies on this matter showed that 1-year administration of oral alendronate weekly was able to decrease bone turnover markers by more than 50 %, thus reproducing the data obtained in seronegative patients [6]. In the meantime, another paper demonstrated that a 2-year treatment with alendronate induced a significant increment of BMD in HIV-infected patients compared to placebo [7]. The data were confirmed a couple of years later when McComsey et al. published the results of a randomized, placebo-controlled, double-blinded phase II trial comparing alendronate and placebo in osteopenic HIV? patients; interestingly, a high rate of men were enrolled in this study (71 %), confirming other data on the efficacy of alendronate in males [8]. One of the biggest inconveniences perceived both by HIV patients and by their doctors is the pills burden. Even though many efforts have been done in order to reduce the number of daily pills, the addition of a drug like alendronate can be felt as a problem. On the contrary, a yearly injection appears to be very appealing solution. This accounts for the early development of studies with annual intravenous injection of zoledronate that have demonstrated that this schedule can produce a significantly higher increase of BMD than placebo [9]. Zoledronic acid is usually given 5 mg intravenous yearly. Less frequent dosing schedules (e.g., every 2 years or every 5 years) have been shown to equally suppress bone turnover and preserve BMD, but the anti-fracture efficacy of these alternative dosing strategies has not been established in any population [10]. Chronic vitamin D deficiency is very frequent in HIVinfected subject [11]. As vitamin D deficiency can blunt bone response to bisphosphonate treatment, cholecalciferol should always be administered before initiating a therapy with an anti-resorptive drug [12]. F. Vescini (&) F. Grimaldi Endocrinology and Metabolism Unit, University-Hospital S. Maria della Misericordia, Udine, Italy e-mail: vescini.fabio@aoud.sanita.fvg.it" @default.
• W2000619372 created "2016-06-24" @default.
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• W2000619372 date "2014-11-26" @default.
• W2000619372 modified "2023-09-26" @default.
• W2000619372 title "Bisphosphonates in the treatment of HIV-related osteoporosis" @default.
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• W2000619372 doi "https://doi.org/10.1007/s12020-014-0488-3" @default.
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