PrEP Does Not Affect Fracture Risk
Tenofovir-containing pre-exposure prophylaxis (PrEP) does not affect fracture risk among young, healthy individuals who use daily PrEP, according to new research.
To assess the impact of PrEP with tenofovir (Truvada) on the bone mineral density of men who have sex with men and transwomen, the researchers conducted dual-energy x-ray absorptiometry scans and dried blood spot collections on 254 study participants every 24 weeks. Participants were recruited as part of the international iPrEx-open-label extension study from June 2011 to December 2013.
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The participants’ average weekly dosing adherence patterns (2, 4, and 7 doses/wk) were estimated from validated tenofovir-diphosphate cut-offs. Using these weekly adherences, the researchers calculated the mean percent bone mineral density change among the participants, all of whom were taking PrEP for the first time.
“The percent decline in spine BMD was monotonically associated with strata of increasing average weekly adherence,” the study authors wrote.
The researchers determined that participants who had very high adherence (daily use) to Truvada experienced a 1.2% decrease in spine bone mineral density and a 0.5% decrease in hip bone mineral density.
According to the study authors, these decreases in bone mineral density are lower than previous studies suggest.
“This drop is likely not clinically significant for most PrEP users,” the researchers concluded. “However, for those at the highest risk of fracture who plan prolonged PrEP use, alternate PrEP strategies could be considered.”
—Colleen Murphy
Reference:
Spinelli MA, Glidden DV, Anderson PL, et al. Impact of estimated pre-exposure prophylaxis (PrEP) adherence patterns on bone mineral density in a large PrEP demonstration project [published online June 19, 2019]. AIDS Res Hum Retroviruses. https://doi.org/10.1089/aid.2018.0297.