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Evidence summaries

Interventions for Decreased Bone Mineral Density Associated with HIV Infection

Bisphosphonate therapy and testosterone in those with AIDS wasting syndrome may be safe and possibly effective methods to improve bone mineral density in HIV patients. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 3 studies with a total of 152 subjects. 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.

Comment: The quality of evidence is downgraded by study quality (inadequate allocation concealment and lack of intention-to-treat analysis and by imprecise results) few patients and wide confidence intervals.

    References

    • Lin D, Rieder MJ. Interventions for the treatment of decreased bone mineral density associated with HIV infection. Cochrane Database Syst Rev 2007 Apr 18;(2):CD005645. [PubMed]

Primary/Secondary Keywords