Background: Osteoporosis is a prevalent metabolic complication in HIV-infected adults. Limited data are available regarding the management of osteoporosis in HIV-uninfected children, and no data is available in HIV-infected children. In addition, there is no data regarding progression of osteopenia or osteoporosis in HIV-infected children.

Methods: Bone mineral density (BMD) of the lumbar spine (L1-L4) was assessed by Dual-Energy-Xray-Absorptiometry (DEXA) and z-scores were calculated using DEXA scan manufacturers' normative population data established by gender, race, and age. Osteoporosis = z-score ≤ -2; osteopenia =  z-score > -2 and ≤ -1.5. Other measured metabolic parameters included triglyceride, cholesterol, calcium, phosphorus (P), alkaline phosphatase (ALP), AST, ALT, and lactate.

Results: Overall, 23 vertically HIV-infected children (median age 8.75 yrs, range 1.25 to 17.67 yrs; 14 females) were enrolled. At first DEXA evaluation, 1 subject was naïve to all antiretrovirals, and 22 were receiving HAART; 13/22 were receiving an NNRTI-based regimen and 9/22 a PI-based regimen. Median duration of antiretrovirals was 46 months (range 4–130). At first DEXA evaluation, the median BMI (kg/m²) and CD4% were 18.35 (range 13.4–35.4) and 35.5% (range 16–44), respectively. Eighty-seven percent (87%; 20/23) had HIV-1 RNA < 400 copies/ml. The median z-score from the first DEXA evaluation was -2 (range -0.2 to -4.5). Overall, 48% (11/23) were classified as osteoporotic and 74% (17/23) as osteopenic. Fifteen (15) children underwent repeat DEXA after a median duration of 10 months (range 5.5–16.5). No changes in z scores were seen over time (p = 0.66). Between the 2 DEXA evaluations, 9 osteoporotic children received daily supplementation with calcium (< 9 years: 500mg; ≥ 9 years: 1000 mg) and vitamin D (200 UI) for a median duration of 9 months (range 5.5–16.5). Their median z scores were -2.7 and -2.1 before and after supplementation, respectively (p = 0.13). There was no significant change in BMI, CD4%, HIV-1 RNA, cholesterol, triglycerides, calcium, P, or ALP between the 2 evaluations in all 15 children.

Conclusions: Osteoporosis and osteopenia are serious metabolic complications with a high prevalence in HIV-infected children. During the study period (median duration of 10 months), no significant decrease in BMD occurred. In addition, no improvement in bone loss was observed in the subgroup of children who received a 9-month course of calcium/vitamin D supplements.