Endocrine Abstracts

Objective: Osteoporosis and vertebral fractures (VFs) are frequently observed in HIV-infected men. Whereas bisphosphonates seem effective on bone mineral density (BMD) maintenance in HIV-men, data on VFs are lacking. We aimed to evaluate the long-term efficacy of bisphosphonates on VFs in HIV-infected men.

Design: Real-life longitudinal retrospective study on 118 consecutive HIV-infected males (median age at inclusion 53 years). Median time between first and second visit was 2 years, and between first and latest visit available was 7 years.

Methods: Inclusion criteria were age >18 years, HIV infection in stable conditions under antiretroviral therapy, no previous bisphosphonates treatment, blood samples carried out at the same laboratory, and three densitometric and morphometric assays performed with the same densitometer.

Results: At baseline, VFs were detected in 29/118 patients (24.6%), of which 18/29 (62.1%) were osteoporotic and 11/29 (37.9%) had osteopenia. Fractured patients were older (P.0.042), had longer HIV infection duration (P.0.046), antiretroviral exposure (P.0.025) and higher luteinizing hormone (LH) (P.0.044). Of the 29 patients already fractured at baseline, 11 (37.9%) developed new VFs during follow-up, of which 8 were under bisphosphonates treatment (P.0.018). Among the 89 patients without baseline VFs, 26/89 (29.2%) were osteoporotic, 50/89 (56.2%) had osteopenia and 13/89 (14.6%) had normal BMD. Of the 89 patients without baseline VFs, 11 (12.4%) developed VFs, being treated with bisphosphonates in only 2 cases (P.0.811). Overall, BMD remained stable over time and a progressive decrease of parathyroid hormone, bone alkaline phosphatase and C-terminal telopeptide was observed. Patients with worsened bone condition, both in term of BMD and VFs (n. 32), showed more frequently LH values > 9.4 mIU/ml (P.0.046) and were more HCV coinfected (P.0.045). Noteworthy, 38.6% of the patients discontinued bisphosphonates, due to medical indication or personal choice, and 14.0% never started them.

Conclusions: We found that bisphosphonates were not completely effective in preventing VFs in patients already suffering from previous VFs, probably due to the multifactorial pathogenesis of fragility fractures in this population and also to poor adherence to medication.