title: Is there enough evidence to use bisphosphonates in HIV-infected patients? A systematic review and meta-analysis.
abstract: An increased prevalence of osteopenia and osteoporosis has been observed in HIV-infected cohorts. We investigated the effect of bisphosphonates on bone mineral density in adults with HIV infection. Outcomes of interest were bone mineral density changes measured by dual-energy X-ray absorptiometry at the lumbar spine, femoral neck, and total hip, and adverse events. Data were pooled using the fixed-effects model. We identified eight randomized controlled trials meeting our inclusion criteria, involving 328 participants. Five trials compared alendronate with placebo or no intervention; in three trials the intervention arm received zoledronate. A significant increase in bone mineral density at the lumbar spine was observed in the bisphosphonate group at 48 weeks (MD: 2.84%; 95% CI: 2.11-3.57) and 96 weeks (MD: 6.76%; 95% CI: 4.98-8.54); analogously, bisphosphonates were associated with an increase in total hip bone mineral density at 48 weeks (MD: 2.12%; 95% CI: 1.43-2.81) and 96 weeks (MD: 3.2%; 95% CI: 1.52-4.88). Bisphosphonates were generally well tolerated; no drug-related withdrawals were reported in the five randomized controlled trials assessing alendronate, whereas two patients out of 104 receiving zoledronate experienced acute-phase reactions. In conclusion, administration of oral and intravenous bisphosphonates was associated with increased bone mineral density at the lumbar spine and total hip over two years in HIV-positive patients. However, none of the included trials were long enough to detect the impact of bisphosphonates on a clinically important outcome such as fracture risk. Larger studies with extended follow-up are warranted.
authors.affiliation: Department of Clinical and Molecular Biomedicine, Division of Infectious Diseases, University of Catania, Catania, Italy.
authors.forename: Marilia Rita
authors.initials: MR
authors.lastname: Pinzone
authors.affiliation: Department of Infectious Diseases, Institute for Health Research (IRICYS), University Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Moreno
authors.affiliation: Department of Clinical and Molecular Biomedicine, Division of Infectious Diseases, University of Catania, Catania, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Cacopardo
authors.affiliation: Department of Clinical and Molecular Biomedicine, Division of Infectious Diseases, University of Catania, Catania, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nunnari
mesh_terms: D015502:Absorptiometry, Photon; D019386:Alendronate / Q000008:administration & dosage; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D001851:Bone Diseases, Metabolic / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control* / Q000821:virology; D004164:Diphosphonates / Q000008:administration & dosage*; D019317:Evidence-Based Medicine; D005272:Femur Neck / Q000473:pathology; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control*; D015658:HIV Infections / Q000150:complications* / Q000503:physiopathology; D006615:Hip / Q000473:pathology; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage; D008159:Lumbar Vertebrae / Q000473:pathology; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control* / Q000821:virology; D016032:Randomized Controlled Trials as Topic; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D019386:Alendronate