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Bone health in children and adolescents with perinatal HIV infection.

Puthanakit T, Siberry GK - J Int AIDS Soc (2013)

Bottom Line: The potential negative effects of tenofovir on BMD and bone mass accrual are of particular concern as this drug may be used more widely in younger children.More data are needed to inform therapies and monitoring for HIV-infected youth with proven bone fragility.While very limited data suggest lack of marked increase in fracture risk for youth with perinatal HIV infection, the looming concern for these children is that they may fail to attain their expected peak bone mass in early adulthood which could increase their risk for fractures and osteoporosis later in adulthood.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

ABSTRACT
The long-term impact on bone health of lifelong HIV infection and prolonged ART in growing and developing children is not yet known. Measures of bone health in youth must be interpreted in the context of expected developmental and physiologic changes in bone mass, size, density and strength that occur from fetal through adult life. Low bone mineral density (BMD) appears to be common in perinatally HIV-infected youth, especially outside of high-income settings, but data are limited and interpretation complicated by the need for better pediatric norms. The potential negative effects of tenofovir on BMD and bone mass accrual are of particular concern as this drug may be used more widely in younger children. Emphasizing good nutrition, calcium and vitamin D sufficiency, weight-bearing exercise and avoidance of alcohol and smoking are effective and available approaches to maintain and improve bone health in all settings. More data are needed to inform therapies and monitoring for HIV-infected youth with proven bone fragility. While very limited data suggest lack of marked increase in fracture risk for youth with perinatal HIV infection, the looming concern for these children is that they may fail to attain their expected peak bone mass in early adulthood which could increase their risk for fractures and osteoporosis later in adulthood.

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Related in: MedlinePlus

Illustration of changes in lumbar spine bone mineral density (BMD) over the lifespan. Plot based on actual or estimated data from three different studies [5–7].
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Figure 0001: Illustration of changes in lumbar spine bone mineral density (BMD) over the lifespan. Plot based on actual or estimated data from three different studies [5–7].

Mentions: The potential impact of HIV infection and treatment on the bone health of youth with perinatal HIV infection must be evaluated in the context of normal, physiologic bone growth and development (Table 2). The effect of HIV infection and its treatment on developing bones may well be different from that seen in adults who acquire HIV infection after bone development is complete. Furthermore, the assessment of potential effects must be made relative to normal or expected changes in bone. For instance, BMD, a commonly used measure of bone strength, normally increases throughout childhood and adolescence, peaks and stays relatively constant in healthy adults, and then begins to decline with older age and especially menopause (Figure 1). An assessment of the effect of an antiretroviral drug on BMD (or BMC) must then be considered against the normal age-related expectation for changes in these parameters.


Bone health in children and adolescents with perinatal HIV infection.

Puthanakit T, Siberry GK - J Int AIDS Soc (2013)

Illustration of changes in lumbar spine bone mineral density (BMD) over the lifespan. Plot based on actual or estimated data from three different studies [5–7].
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3687077&req=5

Figure 0001: Illustration of changes in lumbar spine bone mineral density (BMD) over the lifespan. Plot based on actual or estimated data from three different studies [5–7].
Mentions: The potential impact of HIV infection and treatment on the bone health of youth with perinatal HIV infection must be evaluated in the context of normal, physiologic bone growth and development (Table 2). The effect of HIV infection and its treatment on developing bones may well be different from that seen in adults who acquire HIV infection after bone development is complete. Furthermore, the assessment of potential effects must be made relative to normal or expected changes in bone. For instance, BMD, a commonly used measure of bone strength, normally increases throughout childhood and adolescence, peaks and stays relatively constant in healthy adults, and then begins to decline with older age and especially menopause (Figure 1). An assessment of the effect of an antiretroviral drug on BMD (or BMC) must then be considered against the normal age-related expectation for changes in these parameters.

Bottom Line: The potential negative effects of tenofovir on BMD and bone mass accrual are of particular concern as this drug may be used more widely in younger children.More data are needed to inform therapies and monitoring for HIV-infected youth with proven bone fragility.While very limited data suggest lack of marked increase in fracture risk for youth with perinatal HIV infection, the looming concern for these children is that they may fail to attain their expected peak bone mass in early adulthood which could increase their risk for fractures and osteoporosis later in adulthood.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

ABSTRACT
The long-term impact on bone health of lifelong HIV infection and prolonged ART in growing and developing children is not yet known. Measures of bone health in youth must be interpreted in the context of expected developmental and physiologic changes in bone mass, size, density and strength that occur from fetal through adult life. Low bone mineral density (BMD) appears to be common in perinatally HIV-infected youth, especially outside of high-income settings, but data are limited and interpretation complicated by the need for better pediatric norms. The potential negative effects of tenofovir on BMD and bone mass accrual are of particular concern as this drug may be used more widely in younger children. Emphasizing good nutrition, calcium and vitamin D sufficiency, weight-bearing exercise and avoidance of alcohol and smoking are effective and available approaches to maintain and improve bone health in all settings. More data are needed to inform therapies and monitoring for HIV-infected youth with proven bone fragility. While very limited data suggest lack of marked increase in fracture risk for youth with perinatal HIV infection, the looming concern for these children is that they may fail to attain their expected peak bone mass in early adulthood which could increase their risk for fractures and osteoporosis later in adulthood.

Show MeSH
Related in: MedlinePlus