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Tenofovir treatment raises the risk of broken bones
Keith Alcorn, 2016-02-23 19:00:00

Treatment containing tenofovir is associated with a higher risk of bone fractures in people living with HIV, but a single infusion of zoledronic acid, a drug used in the treatment of osteoporosis, can protect against bone loss, two studies presented at the Conference on Retroviruses and Opportunistic Infections (CROI 2016) in Boston show.

In another study, bone loss associated with the use of tenofovir in pre-exposure prophylaxis (PrEP) was shown to reverse quickly after the use of tenofovir ceased (see separate report).

HIV causes bone loss, and a large case-controlled study in Denmark has shown that HIV infection increases the risk of fractures. There is also evidence of a loss of bone mineral density in the first year after starting antiretroviral therapy.

Tenofovir use is associated with bone mineral loss, although in most people the extent of bone loss is modest, occurs mainly in the first year of treatment and its long-term consequences are unclear. In particular, previous studies which have identified bone loss in people taking tenofovir have not been able to show whether this results in a higher risk of fractures.

Since tenofovir is one of the most widely-prescribed antiretrovirals (contained in Truvada and several fixed dose combinations including Atripla), and because many people will take the drug for prolonged periods, it is important to know more about fractures and a more serious complication of bone mineral loss, osteonecrosis, in which bone dies.