(Last updated: March 1, 2016; last reviewed: March 1, 2016)
|Adverse Effects||Associated ARVs||Onset/Clinical Manifestations||Estimated Frequency||Risk Factors||Prevention/ Monitoring||Management|
|Osteopenia and Osteoporosis||Any cART regimen
Specific Agents of Possible Concern:
||Longer duration of HIV infection
Greater severity of HIV disease
Growth delay, pubertal delay
Prolonged systemic corticosteroid use
Limited weight-bearing exercise
||Ensure sufficient calcium intake and vitamin D sufficiency.
Encourage weight-bearing exercise.
Reduce modifiable risk factors (e.g., smoking, low BMI, use of steroids, use of 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 that population, the prevalence of vitamin D insufficiency is high.
bUntil 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 could also be considered in adolescent women on TDF and medroxyprogesterone and in children with indications not uniquely related to HIV infection (such as cerebral palsy).
Key to Acronyms: ART = antiretroviral therapy; ARV = antiretroviral; BMD = bone mineral density; BMI = body mass index; DXA = dual-energy x-ray absorptiometry; LPV/r = lopinavir/ritonavir; PI = protease inhibitor; TDF = tenofovir disoproxil fumarate