title: Effect of alendronate on HIV-associated osteoporosis: a randomized, double-blind, placebo-controlled, 96-week trial (ANRS 120).
abstract: Low bone mineral density (BMD) is common in HIV-infected patients. Bisphosphonates such as alendronate potently inhibit bone resorption and are effective against osteoporosis. The aim of the ANRS 120 Fosivir trial was to evaluate the effect of alendronate on low BMD in HIV-infected patients. HIV-1-infected adults with a t-score≤-2.5 at the lumbar spine and/or total hip, as assessed by dual x-ray absorptiometry, and no other known risk factors for low BMD, were randomized to receive either extended-release alendronate 70 mg weekly or placebo for 96 weeks, with stratification for gender. All the patients also received daily calcium carbonate (500 mg) and vitamin D (400 U). The primary endpoint for efficacy was the percentage change in BMD at the site with a t-score≤-2.5. Forty-four antiretroviral-treated patients (42 men, 2 women) were enrolled. The median age was 45 years, the median CD4 cell count was 422/mm(3), and viral load was <400 copies/ml in 84% of patients. Baseline characteristics were well balanced between the alendronate (n=20) and placebo (n=24) groups. At baseline, 15 patients (75%) in the alendronate group and 17 patients (71%) in the placebo group had a t-score≤-2.5 at the lumbar spine. In the main analysis, BMD at the site with a t-score≤-2.5 increased by 7.1% and 1.0%, respectively, in the alendronate (n=14) and placebo (n=20) groups at week 96 [mean difference, 6.1% (95% CI 2.8 to 9.3); p=0.0003]. Alendronate 70 mg weekly for 96 weeks improves BMD in HIV-1-infected patients on antiretroviral therapy.
authors.affiliation: AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Rhumatologie, Paris, France. sylvie.rozenberg@psl.aphp.fr
authors.forename: Sylvie
authors.initials: S
authors.lastname: Rozenberg
authors.forename: Emillie
authors.initials: E
authors.lastname: Lanoy
authors.forename: Michelle
authors.initials: M
authors.lastname: Bentata
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Viard
authors.forename: Marc Antoine
authors.initials: MA
authors.lastname: Valantin
authors.forename: Pascale
authors.initials: P
authors.lastname: Missy
authors.forename: Iuliana
authors.initials: I
authors.lastname: Darasteanu
authors.forename: Christian
authors.initials: C
authors.lastname: Roux
authors.forename: Sami
authors.initials: S
authors.lastname: Kolta
authors.forename: Dominique
authors.initials: D
authors.lastname: Costagliola
mesh_terms: D015502:Absorptiometry, Photon; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy*; D000328:Adult; D019386:Alendronate / Q000494:pharmacology / Q000627:therapeutic use*; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000494:pharmacology / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D004311:Double-Blind Method; D005260:Female; D005602:France; D006615:Hip / Q000000981:diagnostic imaging; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D050071:Bone Density Conservation Agents; D019386:Alendronate