Denosumab for the treatment of HIV-associated osteoporosis with fractures in a premenopausal woman
The prevalence of osteoporosis is about three times greater in people living with HIV than in the general population. Bisphosphonates are the only class of antiresorptive drugs which have proved to be safe and effective in HIV patients. However, bisphosphonates are not recommended in women of childbearing age due to an increased rate of associated neonatal complications. To the best of our knowledge no reports on the use of denosumab in HIV-infected individuals have been published so far. We describe a 38 year-old woman with HIV, osteoporosis and vertebral fractures treated with denosumab, a monoclonal antibody targeting RANKL. After four years of treatment, bone mineral density improved, no new fractures occurred, and neither HIV reactivation nor opportunistic infections were observed. We show that denosumab could be a safe and effective approach for osteoporosis in patients with HIV and could be considered in women of childbearing age.
Brown TT, Qaqish RB. Antiretroviral therapy and the prevalence of osteopenia and osteoporosis: a meta-analytic review. AIDS (London, England) 2006; 20: 2165-74. DOI: https://doi.org/10.1097/QAD.0b013e32801022eb
Moran CA, Weitzmann MN, Ofotokun I. Bone Loss in HIV Infection. Curr Treat Options Infect Dis. 2017; 9: 52-67. DOI: https://doi.org/10.1007/s40506-017-0109-9
Cummings SR, San Martin J, McClung MR, et al. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med. 2009; 361: 756-65. DOI: https://doi.org/10.1056/NEJMoa0809493
Lau AN, Wong-Pack M, Rodjanapiches R, et al. Occurrence of serious infection in patients with rheumatoid arthritis treated with biologics and denosumab observed in a clinical setting. J Rheumatol. 2018; 45: 170-6. DOI: https://doi.org/10.3899/jrheum.161270
Premaor MO, Compston JE. The hidden burden of fractures in people living with HIV. JBMR Plus. 2018; 2: 247-56. DOI: https://doi.org/10.1002/jbm4.10055
de la Morena IVS, Paz Solarte JA, Bedoya D, Galindo MJ. Is denosumab safe in HIV patients? EULAR 2019. Ann Rheum Dis. 2019; 78: A1884. DOI: https://doi.org/10.1136/annrheumdis-2019-eular.7858
Langdahl BL. Osteoporosis in premenopausal women. Curr Opin Rheumatol. 2017; 29: 410-5. DOI: https://doi.org/10.1097/BOR.0000000000000400
Stathopoulos IP, Liakou CG, Katsalira A, et al. The use of bisphosphonates in women prior to or during pregnancy and lactation. Hormones (Athens, Greece) 2011; 10: 280-91. DOI: https://doi.org/10.14310/horm.2002.1319
McComsey GA, Tebas P, Shane E, et al. Bone disease in HIV infection: a practical review and recommendations for HIV care providers. Clin Infect Dis. 2010; 51: 937-46. DOI: https://doi.org/10.1086/656412
Heath KV, Montaner JS, Bondy G, et al. Emerging drug toxicities of highly active antiretroviral therapy for human immunodeficiency virus (HIV) infection. Curr Drug Targets 2003; 4: 13-22. DOI: https://doi.org/10.2174/1389450033347109
Masia M, Padilla S, Robledano C, et al. Early changes in parathyroid hormone concentrations in HIV-infected patients initiating antiretroviral therapy with tenofovir. AIDS Res Hum Retrovir. 2012; 28: 242-6. DOI: https://doi.org/10.1089/aid.2011.0052
Orwoll E, Teglbjaerg CS, Langdahl BL, et al. A randomized, placebo-controlled study of the effects of denosumab for the treatment of men with low bone mineral density. J Clin Endocrinol Metab. 2012; 97: 3161-9. DOI: https://doi.org/10.1210/jc.2012-1569
Papapoulos S, Lippuner K, Roux C, et al. The effect of 8 or 5 years of denosumab treatment in postmenopausal women with osteoporosis: results from the FREEDOM Extension study. Osteoporos Int. 2015; 26: 2773-83. DOI: https://doi.org/10.1007/s00198-015-3234-7
Louthrenoo W. Treatment considerations in patients with concomitant viral infection and autoimmune rheumatic diseases. Best Pract Res Clin Rheumatol. 2015; 29: 319-42. DOI: https://doi.org/10.1016/j.berh.2015.05.010
Cummings SR, Ferrari S, Eastell R, et al. Vertebral fractures after discontinuation of denosumab: a post hoc analysis of the randomized placebo-controlled FREEDOM Trial and Its Extension. J Bone Mineral Res. 2018; 33: 190-8. DOI: https://doi.org/10.1002/jbmr.3337
Pfeiler GS, Egle D, Greil R, et al. Fracture risk after stopping adjuvant denosumab in hormone receptor positive breast cancer patients on aromatase inhibitor therapy – an analysis of 3,425 postmenopausal patients in the phase III ABCSG-18 trial. ASBMR 2018 Annual Meeting, 2018: Oral Presentations, Presentation Number: LB-1167.
Kunizawa K, Hiramatsu R, Hoshino J, et al. Denosumab for dialysis patients with osteoporosis: A cohort study. Sci Rep. 2020; 10: 2496. DOI: https://doi.org/10.1038/s41598-020-59143-8
- Abstract views: 2729
- PDF: 164
Copyright (c) 2021 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.