Evaluation of the Efficacy of Using Intravenous Zoledronic Acid Versus Oral Bisphosphonates in the Treatment of Osteoporosis in Patients with HIV

Abstract

Introduction: People Living with Human Immunodeficiency Virus (PLHIV) have an increased risk of developing osteoporosis due to HIV infection per se, antiretroviral treatment, and factors associated with ageing resulting from the increase in the average life expectancy of this people. Our aim was to compere the efficacy of using intravenous zoledronic acid annual versus oral bisphosphonate weekly therapy for osteoporosis in PLHIV. Methods: This retrospective study analysed fifty-five HIV-infected patients diagnosed with osteoporosis, followed-up over a period of four years at the Department of Infectious, Centro Hospitalar São João. Demographic and clinical data were collected, including age, sex, body mass index (BMI), duration of HIV, and antiretroviral therapy, measures related to bone mineral density (BMD) of the lumbar spine and femoral neck, serum levels of creatinine, urea, estimated glomerular filtration rate (eGFR), alkaline phosphatase, total calcium, phosphorus, magnesium, vitamin D [25-OH-Vitamin D], and parathyroid hormone (PTH).T-test and Mann-Whitney U test were employed to analyse the data according to the distribution of variables. Results: The results revealed no significant differences in BMD of lumbar spine or femoral neck between the two groups (p > 0.05). Biochemical parameters evaluated and estimated glomerular filtration rate (eGFR) did not differ significantly between the groups, except for creatinine levels at certain time points (p values ranging from 0.004 to 0.09). Conclusions: We observed that both oral and intravenous bisphosphonate formulations are effective in increasing the BMD in HIV-infected patients with osteoporosis and was not possible to determine which formulation was superior. Adherence to treatment proved to be an important factor to be consider.