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Interventions for the treatment of decreased bone mineral density associated with HIV infection

  • Review
  • Intervention




Decreased bone mineral density (BMD) occurs more commonly in patients with HIV than in the general population, making this group more susceptible to fragility fractures. However, bone loss is under-treated in patients with HIV.


To assess the effects of interventions aimed at increasing bone mineral density in HIV-infected adults.

Search methods

We searched MEDLINE, EMBASE, LILACS, The Cochrane Library, Meeting Abstracts, AIDSTRIALS, ACTIS, Current Controlled Trials, National Institutes of Health Clinical Trials Registry, and CenterWatch (search date July 2006).

Selection criteria

Randomised trials comparing any pharmacological or non-pharmacological therapy with placebo, no treatment, or an alternative therapy, with the goal of increasing bone mineral density in adult (age 18 years or over) patients with HIV.

Data collection and analysis

Two reviewers independently assessed trial eligibility and quality, and extracted data. Where data were incomplete or unclear, conflicts were resolved with discussion and/or trial authors were contacted for further details.

Main results

Three completed randomised-controlled studies examined the role of alendronate in patients with HIV and osteopenia or osteoporosis. When all three studies were combined, much heterogeneity was seen (p<0.0001), most likely due to different populations and interventions. A sensitivity analysis showed that in two studies without heterogeneity (p=0.11), alendronate, calcium and vitamin D improved lumbar BMD after one year when compared with calcium and vitamin D (weighted mean difference +2.65 95% confidence interval (CI) 0.80, 4.51 percent). However the alendronate group did not have less fragility fractures, relative risk (RR) 1.28 (95% CI 0.20, 8.21), or osteoporosis, RR 0.50 (95% CI 0.24, 1.01). Adverse events were not significantly different between groups, RR 1.28 (95% 0.20, 8.21). One randomised-controlled study done in patients with AIDS wasting found that after three months, testosterone enanthane improved lumbar BMD compared to placebo by +3.70 (95% CI 0.48, 6.92) percent, but progressive resistance training did not improve lumbar BMD (+0.40 95% CI -2.81, 3.61 percent). No group in this study had any adverse effects.

Authors' conclusions

The very limited data reviewed showed that bisphosphonate therapy andin those with AIDS wasting syndrome, testosteronemay be safe and possibly effective methods to improve bone mineral density in HIV patients. The available studies are small, of short duration, and not powered to detect changes in WHO categories and fracture rates.

Larger studies using bisphosphonates are currently underway. The role of colecalciferol, androgen replacement in women, and growth hormone are also under investigation.




人類免疫缺乏病毒感染的病患,骨質密度(bone mineral density, BMD)較正常人低,使得這群病患更容易發生脆弱性骨折(fragility fracture)。可是對於人類免疫缺乏病毒感染的病患骨質流失的治療是常被忽視的。




我們搜尋的文獻系統包括:MEDLINE、EMBASE、LILACS、考科藍圖書館(The Cochrane Library)、會議摘要(Meeting Abstracts)、愛滋病臨床試驗(AIDSTRIALS)、ACTIS、當今隨機對照臨床試驗註冊資料庫(Current Controlled Trials)、國家衛生研究院臨床試驗註冊資料庫(National Institutes of Health Clinical Trials Registry)、以及CenterWatch等(搜尋日期:2006年7月)。






有3個完成的隨機對照研究檢驗了alendronate對於人類免疫缺乏病毒病患骨質缺少(osteopenia)或骨質疏鬆(osteoporosis)的角色。當3篇研究整合在一起時,其異質性(heterogeneity)很大(p值<0.0001),最可能是因為不同的研究族群與治療處置所致。進行敏感度分析後發現,其中2個沒有異質性的研究(p值=0.11)顯示,alendronate合併鈣質與維生素D使用1年後,比起使用鈣質與維生素D,可改善腰椎的骨質密度(加權平均差異(weighted mean difference)+2.65%,95%信賴區間0.80~4.51%)。但是alendronate治療組的病患,在脆弱性骨折或骨質疏鬆的發生率都沒有較低,二者的相對風險分別為1.28(95%信賴區間0.20~8.21)與0.50(95%信賴區間0.24~1.01)。副作用的發生率,在治療組和對照組間無顯著差異,相對風險為1.28(95%信賴區間0.20~8.21)。有1個隨機對照研究,研究對象是愛滋病患者併體質耗弱症候群(AIDS wasting),該研究發現,在使用睪固酮(testosterone enanthane) 3個月後,比起安慰劑可以增加腰椎骨質密度達3.70%(95%信賴區間0.48~6.92),而累進式阻抗訓練(progressive resistance training)則不會增進腰椎骨質密度(+0.40%,95%信賴區間−2.81~3.61)。這個研究裡兩組均沒有任何副作用。


回顧這些非常有限的資料顯示,雙磷酸鹽類(bisphosphonate)及睪固酮(針對那些愛滋病患者併體質耗弱症候群)對於改善人類免疫缺乏病毒病患的骨質密度,可能是安全而有效果的。但目前已有的都是小型且時程短的研究,不足以偵測到在骨質密度的WHO分類的改變及骨折率。目前已有更大型的研究評估雙磷酸鹽類的效果,而維生素D3 (colecalciferol)、女性使用雄性素替代療法、以及生長激素等治療,都仍在研究中。



此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。



Plain language summary

Drug-based and non-drug-based interventions to improve the bone mineral density in patients living with HIV

Osteoporosis is caused by bone loss, and people who have the condition are at higher risk of having a fracture. Measuring a person's bone mass density (BMD) is a way to measure his or her risk of having a fracture due to fragile bones. Decreased BMD is much more common in HIV patients than in the general population. The cause of this decrease is not certain, but it may be because of the HIV infection itself or because of the antiretroviral medications that patients with HIV take. Although patients with HIV often get fractures because of their sometimes more fragile bones, it has been shown that this bone loss is often not effectively treated in this population. This review examines the randomised controlled trials investigating treatments for bone loss in patients with HIV infection.

Three trials examined the use of the drug alendronate to improve BMD in patients with HIV. These three studies were quite different from each other in terms of the populations studied and the interventions used, but even similar studies did not always have heterogeneity. A fourth study examined the use of testosterone in male patients with HIV and AIDS wasting syndrome. The four studies in this review were limited by the fact they were all very small and lasted a short amount of time, and thus they were unable to detect prevention of fractures or changes in number of patients with osteoporosis. There were also further compromises in study design. However, the limited available data show that there may be safe and perhaps effective treatments in the form of alendronate for patients with HIV who have decreased bone mineral density and, in those with AIDS wasting syndrome, testosterone.

Larger studies further examining the issue of decreased BMD are currently underway.

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