The effect of risedronate on hypogonadal osteoporotic HIV males treated with highly active anti-retroviral therapy: a pilot study

Jessica Pepe; Andrea M Isidori; Mario Falciano; Giancarlo Iaiani; Alessandra Salotti; Daniele Diacinti; Fiacco Romano Del; Emilia Sbardella; Cristiana Cipriani; Sara Piemonte; Orlando Raimo; Antonella D; Elisabetta Romagnoli; Andrea Lenzi; Salvatore Minisola

doi:10.1530/boneabs.3.PP314

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Bone Abstracts (2014) 3 PP314 | DOI: 10.1530/boneabs.3.PP314

ECTS2014 Poster Presentations Osteoporosis: treatment (68 abstracts)

The effect of risedronate on hypogonadal osteoporotic HIV males treated with highly active anti-retroviral therapy: a pilot study

Jessica Pepe ¹ , Andrea M Isidori ² , Mario Falciano ³ , Giancarlo Iaiani ³ , Alessandra Salotti ³ , Daniele Diacinti ⁴ , Romano Del Fiacco ¹ , Emilia Sbardella ² , Cristiana Cipriani ¹ , Sara Piemonte ¹ , Orlando Raimo ¹ , Antonella D’angelo ¹ , Elisabetta Romagnoli ¹ , Andrea Lenzi ² & Salvatore Minisola ¹

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¹Department of Internal Medicine and Medical Disciplines, Sapienza Univeristy, Rome, Italy; ²Department of Experimental Medicine, Sapienza University, Rome, Italy; ³Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy; ⁴Department of Radiology, Sapienza University, Rome, Italy.

Objective: We evaluated the effect of risedronate on BMD and bone turnover markers in HIV infected osteoporotic males, according to their gonadal status.

Methods: 41 HIV patients treated with highly active anti-retroviral therapy (HAART) were followed for 24 months and divided into two groups: patients with osteoporosis or osteopenia with fractures (Group A, n=20) and those without (Group B, n=21). Group A and B were further divided according to the presence of a reduced calculated free testosterone (≤225 pmol/l), a better marker of androgenization in HIV given the raised SHBG level, and/or severe symptoms of hypogonadism defined as >37 score at the aging male symptoms scale (AMS). Both groups were treated with cholecalciferol 800 IU and calcium 1000 mg orally every day for the first 12 months. Risedronate 75 mg for 2 consecutive days a month orally was then added in Group A, for another 12 months. Group B continued treatment with calcium and vitamin D for the entire study length (24 months). Every 6 months each patient underwent biochemical evaluation, AMS questionnaire, lumbar and femoral BMD measurement.

Results: During the study period, the HAART therapy was unchanged. A significant increase in lumbar BMD was observed in HIV males with adequate androgenization after 12 months of risedronate treatment in Group A compared to hypogonadal subjects (5.2±1.0 vs 3.1±0.8%, S.E.M., P<0.05); a significant greater reduction of βCTX (−19.8±0.8 vs −16.1±0.9%, S.E.M., P<0.05) was also observed. BMD remained stable with a concomitant significant modest reduction (P< 0.05 vs basal values) of bone turnover markers in Group B.

Conclusions: Risedronate increased BMD and reduced bone turnover markers at a greater extent in eugonadal compared to hypogonadal osteoporotic HIV males, emphasizing the role of gonadal status in determining response to treatment in young HIV males.