ART: Daily Vitamin D and Calcium Stave Off Bone Loss

Diedtra Henderson

June 15, 2015

Patients with HIV infection who take antiretroviral therapy (ART) can also reduce antiretroviral therapy-related bone loss by 50% by taking daily high-dose vitamin D and calcium supplements, according to a 48-week study.

Edgar Turner Overton, MD, from the University of Alabama School of Medicine in Birmingham, and colleagues report the findings of their prospective, randomized, double-blind, placebo-controlled study in an article published online June 15 in the Annals of Internal Medicine.

ART is among a number of beneficial medical therapies that sap strength from the bones, with patients losing 2% to 6% of bone mineral density from their hips and spines¬, akin to the amount of bone loss seen in the first year of menopause, within 24 to 48 weeks of starting the life-saving regimen.

From September 2011 to February 2012, the researchers recruited 165 patients with HIV who had not yet begun ART. As the patients began their first ART regimen, the researchers randomly assigned 79 of them to receive 4000 IU of vitamin 3 and 1000 mg calcium daily, whereas 86 received placebo. Some 90% of the eligible patients were men; 33% were non-Hispanic black, 37% were non-Hispanic white, and 25% were Hispanic.

"Supplementation with high-dose vitamin D3 (4000 IU) and calcium carbonate (1000 mg) with ART initiation increased 25-(OH)D levels and attenuated increases in bone turnover markers and bone loss at the hip and lumbar spine by approximately 50% at 48 weeks," Dr Overton and colleagues write. "These results mark the first successful intervention to attenuate bone loss with ART initiation and demonstrate the benefit of vitamin D and calcium supplementation to promote bone health in persons with HIV."

Because people with HIV are living almost as long as people who are uninfected, the authors write that preserving their bone health may have an effect on fragility fractures later in life. Because they only studied the efavirenz/emtricitabine/tenofovir disoproxil fumarate combination, it is unclear whether the results apply to other ART regimens.

"Vitamin D and calcium supplementation is a low-cost, well-tolerated intervention to prevent ART-related bone loss," the authors conclude. "Future studies will examine alternative vitamin D doses, effects when used with other ART regimens and in international settings, and longer-term efficacy."

Financial support for the study was provided by the National Institute of Allergy and Infectious Diseases. Bristol-Myers Squibb and Gilead funded the dual-energy X-ray absorptiometry scans and laboratory testing. Study medications were provided by Bristol-Myers Squibb, Gilead Sciences, and Tishcon. Dr Overton and all but one coauthor disclose having received grants from the National Institutes of Health and grants and/or personal fees from and/or serving as a consultant or paid lecturer for one or more of the following: AbbVie, Bristol-Myers Squibb, EMD Serono, Gilead Sciences, GlaxoSmithKline, Merck, Pfizer, Theratechnologies, and ViiV Healthcare. The remaining author has disclosed no relevant financial relationships.

Ann Intern Med. Published online June 15, 2015.

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