(Last updated: February 12, 2014; last reviewed: February 12, 2014)
|Adverse Effects||Associated ARVs||Onset/Clinical Manifestations||Estimated Frequency||Risk Factors||Prevention/ Monitoring||Management|
|Osteopenia and Osteoporosis||cART, especially following initiation and regardless of regimen
Specific Agents of Possible Concern:
||Longer duration of HIV infection Greater severity of HIV disease Growth delay, pubertal delay Low BMI Lipodystrophy Non-black race Smoking Corticosteroid use Medroxy-progesterone use||Prevention:
|Ensure sufficient calcium and vitamin D intake. Encourage weight-bearing exercise. Reduce modifiable risk factors (e.g., smoking, low BMI, use of steroids, medroxyprogesterone). Role of bisphosphonates not established in children Consider change in ARV regimen.|
a Some experts would periodically measure 25-OH-vitamin D, especially in HIV-infected urban youth because, in this population, the prevalence of vitamin D insufficiency is high.
b Until more data are available about the long-term effects of TDF on bone mineral acquisition in childhood, some experts would obtain a DXA at baseline and every 6 to 12 months for prepubertal children and children in early puberty who are initiating treatment with TDF. DXA should also be obtained in children with indications not uniquely related to HIV infection (such as cerebral palsy).
Key to Acronyms: ARV = antiretroviral; BMD = bone mineral density; BMI = body mass index; cART = combination antiretroviral therapy; d4T = stavudine; DXA = dual energy x-ray absorptiometry; LPV/r = lopinavir / ritonavir; PI = protease inhibitor; TDF = tenofovir disoproxil fumarate