Zoledronic Acid Inhibited Bone Loss in HIV Patients

A new clinical trial from Emory University has shown that one dose of zoledronic acid inhibited bone loss in HIV-infected patients—this loss is increased during the first two years of antiretroviral therapy (ART). Bone loss also leads to a higher rate of fracture in HIV-infected individuals, as indicated in the February 23, 2016 news release.

Study co-authors were Igho Ofotokun, Ph.D., associate professor of medicine (infectious diseases) at Emory University School of Medicine and M. Neal Weitzmann, Ph.D., associate professor of medicine (endocrinology) at Emory School of Medicine and the Atlanta Veterans Affairs Medical Center.

“Researchers studied HIV positive individuals, ages 30 to 50 years, who did not have osteoporosis, had no history of immunological disease other than HIV, had serum vitamin D and calcium levels within the normal range, and normal CBC and blood chemistry profiles. The study excluded patients who had osteoporosis, those with planned or recent invasive dental procedures, active peptic ulcer disease or recent history of GI bleed, and pregnant or breastfeeding women. Outcome measures included a marker of bone loss (CTx), and osteocalcin, a marker of bone formation. A bone marrow density scan was used to measure osteopenia and osteoporosis. The study also measured tolerability and safety.”

“Treatment with zoledronic acid was associated with a 73% and a 65% reduction in bone loss relative to placebo at 12 weeks and 24 weeks, respectively, an effect that lasted throughout the 48 weeks of the study.”

“Enhanced bone loss was seen in almost all participants in the placebo arm of the study, while no participant in the treatment arm had an appreciable rise in bone loss. Participants in the placebo arm had a compensatory increase in bone formation, which was an expected result, but bone formation was flat in the treatment arm. Treatment with zoledronic acid was associated with an eight percent increase in lumbar spine bone marrow density at 12 weeks relative to the placebo arm, with an 11 percent increase at 24 and 48 weeks.”

“We are encouraged that our protocol was able to prevent bone loss in HIV patients on ART therapy, ” said Ofotokun in the news release. “These effects occurred early and last through 48 weeks, which is the period when ART-induced bone loss is most intense. This could be an opportunity for effective prophylaxis for preventing bone loss.”

The current study was sponsored by the National Institute on Aging of the National Institutes of Health.