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Session 103
Poster Abstracts Bone Metabolism Abnormalities Monday, 1:30 - 3:30 pm Poster Hall |
Background: Osteopenia and osteoporosis are frequent complications of HIV infection and may be related with low trauma fractures. Gender differences, with an increased prevalence of osteoporosis in male patients, have been observed. We conducted a 104-week prospective, randomized, open-label study to evaluate the effects of alendronate, vitamin D, and calcium supplementation on bone metabolism and bone mineral density in patients with HIV infection. Interim analysis at 52 weeks is presented
Methods: We randomized 41 subjects on HAART with lumbar spine bone mineral density t-scores <-1.0, to receive 70 mg of alendronate (n = 18) or not (n = 23) weekly. All subjects received supplementation of calcium (1000 mg daily) and vitamin D (500 IU daily). T-test statistic was performed.
Results:
|
|
Alendronate
+ Vit D + Ca (cases) |
Vit D + Ca (controls) |
p |
|
Baseline characteristics |
|||
|
Males |
72.2 % |
69.6 % |
0.85 |
|
Age |
45.5 ± 3.6 |
42.5 ± ±3.5 |
0.85 |
|
Average duration of HIV
infection (yrs) |
10.8 ± 2.4 |
10.7 ± 2.2 |
0.94 |
|
CD4 nadir |
184.1 ± 114.4 |
141.4 ± 55.3 |
0.47 |
|
BMI |
21.6 ± 1.9 |
23.8 ± 1.9 |
0.10 |
|
CDC group C |
61.1% |
43.5% |
0.42 |
|
Bone Alk. Phosp |
23.3±13.1 |
23.6±7.3 |
0.92 |
|
Plasma crosslaps |
11559.2±27671.3 |
5966±2319.0 |
0.36 |
|
Daily calcium intake |
896.4±480.7 |
950.6±599.8 |
0.75 |
|
Corrected calcium |
2.1±1.0 |
2.1±1.4 |
0.98 |
|
Urinary Calcium excretion |
191.7±185.3 |
212.3±162.7 |
0.73 |
|
Urinary Calcium /body
weight |
2.4±1.2 |
3.2±2.9 |
0.30 |
|
Phosphate (serum) |
3.4±0.5 |
3.2±0.4 |
0.26 |
|
Phosphate (urine) |
732.6±393.8 |
717.6±363.4 |
0.90 |
|
Lumbar spine bone mineral
density |
0.9 ± 0.0 |
0.9 ± 0.0 |
0.73 |
|
Femoral bone mineral
density |
0.7± 0.0 |
0.7 ± 0.0 |
0.47 |
|
Treatment outcome w 52 |
|||
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Bone mineral density spine |
0.9±0.1 |
0.9±0.1 |
0.59 |
|
Bone mineral density
femoral neck |
0.7±.01 |
0.7±0.0 |
0.62 |
|
Bone alk. phosp |
15.0±8.0 |
18.2±7.4 |
0.34 |
|
Plasma crosslaps |
1914.5±1433.4 |
3967 ±1650.5 |
0.005 |
|
Corrected calcium |
2.3±1.1 |
2.5±2.6 |
0.82 |
|
Urinary calcium excretion |
296.3±258.3 |
229.3±119.5 |
0.39 |
|
Urinary calcium /body
weight |
4.8±3.5 |
3.2±1.7 |
0.13 |
|
Phosphate (serum) |
3.1±0.4 |
3.2±0.6 |
0.60 |
|
Phosphate (urine) |
872.7±530.1 |
768.9±341.1 |
0.53 |
Two fractures due to minimal trauma in each group were observed (3 fractures of the wrist and 1 of the clavicle). Lumbar spine bone mineral density increased by 4% (p = 0.004) within cases and 3.7% (p = 0.62 ) within controls; femoral neck decreased respectively of -0.5% (p = 0.05) and -3.5% (0.04) within cases and controls.
Conclusions: Alendronate is effective to reduce bone turnover (plasma crosslaps) in the treatment of osteopenia/osteoporosis associated with HIV infection having a greater impact on trabecular bone (lumbar spine) than on cortical bone.
Keywords: osteoporosis; osteopenia; bone turn over