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Annual Zoledronate Increases Bone Density in Highly Active Antiretroviral Therapy-Treated Human Immunodeficiency Virus-Infected Men: A Randomized Controlled Trial

Departments of Medicine (M.J.B., A.B.G., A.M.H., G.D.G., I.R.R.), and Molecular Medicine and Pathology (S.E.B., M.G.T., R.B.E.-P.), University of Auckland, Auckland 1020, New Zealand; and Department of Infectious Diseases (S.E.B., M.G.T., R.B.E.-P., A.F.W.), Auckland Hospital, Auckland 1020, New Zealand

Address all correspondence and requests for reprints to: Mark J. Bolland, MBChB, Osteoporosis Research Group, Department of Medicine, University of Auckland, Private Bag 92 019, Auckland 1020, New Zealand. E-mail: m.bolland{at}auckland.ac.nz.

Context: Recent studies have reported low bone mineral density (BMD) in HIV-infected patients. Annual iv administration of 4 mg zoledronate has been shown to increase BMD and suppress bone turnover in postmenopausal women.

Objective: The objective of the study was to determine whether annual administration of 4 mg zoledronate will increase BMD in HIV-infected men receiving highly active antiretroviral therapy.

Design and Setting: A 2-yr randomized placebo-controlled trial was conducted in a clinical research center.

Participants: A total of 43 HIV-infected men were treated with highly active antiretroviral therapy for at least 3 months, with BMD T score less than –0.5.

Intervention: Participants received annual iv administration of 4 mg zoledronate or placebo. All participants took 400 mg/d calcium and 1.25 mg/month vitamin D.

Measurements: BMD at the lumbar spine, total hip and total body, and bone turnover markers were measured.

Results: At the lumbar spine, BMD increased by 8.9% over 2 yr in the zoledronate group compared with an increase of 2.6% in the control group (P < 0.001). At the total hip, BMD increased by 3.8% over 2 yr in the zoledronate group compared with a decrease of 0.8% in the control group (P < 0.001). At the total body, BMD increased by 2.3% over 2 yr compared with a decrease of 0.5% in the control group (P < 0.001). Urine N-telopeptide decreased by 60% at 3 months in the zoledronate group and thereafter remained stable.

Conclusions: Annual administration of zoledronate is a potent and effective therapy for the prevention or treatment of bone loss in HIV-infected men. The current data provide the first trial evidence of the BMD effects of annual zoledronate beyond 1 yr in any population, as well as being the first reported trial in men.