Pathological fractures in AIDS patients with osteopenia and osteoporosis induced by antiretroviral therapy

Osteopenia and osteoporosis have recently been included among the metabolic complications of antiretroviral therapy in HIV-infected patients. The pathogenesis and particularly the role of each individual medication are currently poorly understood. The prevalence and natural history of these conditions have been evaluated only in cross-sectional studies [1], so that their clinical evolution is still unclear. Avascular osteonecrosis has also been described among AIDS patients receiving or not receiving antiretroviral therapy, suggesting that this is a real phenomenon and not a spurious association [2-6]. However, pathological bone fractures have never been reported in patients with bone alterations induced by antiretroviral therapy.We report on two AIDS patients, one with osteopenia and the other with osteoporosis, who suffered fractures after trivial trauma. Both had moderate central and peripheral lipodystrophy, without any significant alterations in lipid metabolism. A dual energy X-ray absorptiometry (DEXA) scanner was used to determine the bone mineral density of the whole body, lumbar spine (L1-L5) and proximal femur.