Zoledronate Protects HIV Positive Men against Bone Loss for at Least 5 Years

This is groundbreaking 

Two doses sustain increases in bone density past 5 years (plus calcium and vitamin D)

http://www.hivandhepatitis.com/hiv-related-conditions/hiv-bone-loss-osteoporosis/3542-zoledronate-protects-hiv-positive-men-against-bone-loss-for-at-least-5-years

A New Book on the Medical Use of Anabolic Steroids

A New Book on the Medical Use of Anabolic Steroids

Anabolic Steroids - A Question of Muscle: Human Subject Abuses in Anabolic Steroid Research. By Dr Michael Scally

Available at Amazon.com

http://www.amazon.com/Anabolic-Steroids-Question-Subject-Research/dp/096622311X/ref=sr_1_1?ie=UTF8&s=books&qid=1232669135&sr=1-1


My review:

Along with Michael Mooney, I am the co-author of the book "Built to Survive: a comprehensive guide to the medical use of anabolic therapies, nutrition and exercise for HIV+ men and women." I am very happy to see that Dr Scally spent months of work researching the effects of anabolics on the Hypothalamic Pituitary Testicular Axis (HPTA)and how these compounds can cause long term hypogonadism (low testosterone) if not used properly.
Most doctors in clinical practice are not trained on how to avoid hypogonadism after anabolic steroid use for medical and non medical purposes. We have used them with great results them for HIV wasting for many years using good physician monitoring. Hopefully, this book will make it possible for clinicians to learn the main issues surrounding the proper use of these life-saving compounds.

I am so glad that Dr Scally wrote a simple explanation on a protocol that may help reset our body's own hormonal axis to prevent the debilitating effects of "post-steroid crashing." There are no published data on the subject, so this book is groundbreaking.

Dr Scally reviews data on the use of anabolic steroids for the following medical uses:

- To treat wasting syndrome related to the Human Immunodeficiency Virus (HIV),
- To treat strength and weight loss associated with Chronic Obstructive Pulmonary Disease (COPD) and Chronic Kidney Disease/Hemodialysis
- To counteract osteoporosis and the negative effects of glucocorticoids on bone density and lean body mass,
- To reverse and prevent the age-related loss of lean body mass (Sarcopenia.)

For physicians and lay people who love to read easy-to-understand clinical information, this book is for you. Every man using testosterone or anabolic steroids should do their research to avoid the most common and untreated side effect caused with the use of these compounds. When used correctly with solid research data and monitoring, anabolics can be great to improve quality of life and lean tissue in people suffering from many debilitating conditions. However, most of the benefits disappear after their use is stopped and quality of life tends to worsen unless an effective HPTA reset protocol is used. This book explains such approach.

Nelson Vergel

Should I take Vitamin D if I am taking Viread or Truvada?

Vitamin D and Viread. Should I be concerned?
Dec 1, 2008

Dear Nelson:

Thanks for what you do for us

I just read an email that said that a study showed that people on Viread had low vitamin D and may have problems with bone. Should I take Vitamin D with Viread?

I do not want to have broken bones as I age

Tony



Response from Mr. Vergel

Dear Tony

Researchers at Mount Sinai School of Medicine recently presented a very interesting paper at the ICAAC 2008 conference on this issue. As you well know, Tenofovir (Viread) is probably the best nucleoside analog out there with the least problems with lipoatrophy and other side effects. However, it has been associated with kidney issues in some treatment experienced patients and also with loss of bone density in some studies. It seems that the bone effects are greater in those taking tenofovir with boosted protease inhibitors. Unfortunately, most of us do not know we have low bone density until we get a fracture.

Vitamin D is needed by our bodies to metabolize calcium to build up bone. Most of it is made when our skin in exposed to sunlight. Many people do not get enough sun in winter months.

In this study, most patients on tenofovir had low Vitamin D levels in their blood (measured as 25(OH)D). 39% of those with low Vitamin D levels also had high parathyroid hormone levels (PTH)

PTH is produced in the parathyroid glands which are four pea-sized glands located on the thyroid gland in the neck. Though their names are similar, the thyroid and parathyroid glands are entirely different glands, each producing distinct hormones with specific functions. The parathyroid glands secrete PTH, a substance that helps maintain the correct balance of calcium and phosphorus in the body. PTH regulates the level of calcium in the blood, release of calcium from bone, absorption of calcium in the intestine, and excretion of calcium in the urine.

When the level of calcium in the blood falls too low, the parathyroid glands secrete just enough PTH to restore the blood calcium level. High PTH usually means that there may be some bone loss problems. Low Vitamin D is known to cause hyperparathyrodism (high PTH).

The study investigators hypothesize that Viread's effect on bone may be related to this low Vit D/high PTH effect. More studies are needed with a larger number of patients

You may want to ask your doctor to measure 25 (OH) D levels. I am also an activist who is trying to get DEXA bone scans to be part of standard of care for people with HIV. It would be great to get a DEXA bone scan before someone starts HAART and then repeated it every two to three years to see how your bones are doing on therapy.

By the way, HIV infection by itself has also been associated with loss of bone density. But some medications may also add to this problem.

Bone density research in HIV is progressing. I tell people to work out with weights and machines, to get at least 30 minutes of sun a day, and to make sure their thyroid hormones and testosterone are in normal range to prevent bone loss. Some people would also benefit from taking Calcium/Vitamin D supplements and/or precription drugs approved to increase bone density.

Talk to your doctor since this is very new data.

Nelson

Comparative Analysis of HIV+ and HIV- Interaction with Testosterone on Bone Mineral Density

Thanks to Jules Levin for providing this paper

Comparative Analysis of HIV+ and HIV- Interaction with Testosterone on Bone Mineral Density



Reported by Jules Levin

ICAAC/IDSA Oct 28 2008 Wash DC



R.RAGHUNATHAN 1,2,J.SINACORE 2,K.RYCHLIK 2, J.FARANO 1,C.PACHUCKI 1,2,and N.AZAD 1,2

1 Edward Hines VA Hospital

Hines, VA 60141

2 Loyola University Health System,Maywood, IL 60153



AUTHOR CONCLUSIONS



In age-matched HIV-infected men, a lower free testosterone corresponds significantly to a lower T-score at the lumbar spine.



A normal free testosterone level was protective of bone mineral density in HIV-infected patients compared to the control population.



Among HIV-uninfected men, an increase in free testosterone level does not correspond to an increase in T-scores.


Further studies evaluating the interaction of low free testosterone and HIV infection need to be conducted to better understand the bone-related effects.


Background: Given an increasingly younger HIV population with osteopenia/osteoporosis a retrospective controlled study was conducted to investigate the effects of testosterone on bone mineral density (BMD) in HIV infected and HIV non-infected populations.



Methods: A chart review was done on a group of 80 male HIV patients and 154 male control patients. The following variables were obtained from the HIV group: age, race, employment status, smoking, body mass index (BMI), duration of HIV, CD4 levels, viral load, type of antiretroviral use, co-morbidities, use of prednisone, heroin, alcohol, methadone use, ever use of androgen, bisphosphanate use, calcium use, alpha reductase inhibitor use, phosphodiesterase inhibitor use, lipids, and biochemical markers. The same variables were obtained from the control group except those pertaining to HIV and employment status. T-scores were used in both HIV and control groups to evaluate BMD.



Results: A univariate analysis of variance was used controlling for the following factors: age, race, BMI, prednisone, heroin, alcohol, smoking, methadone, androgen use, alpha reductase inhibitor use, phosphodiesterase inhibitor use, bisphosphanate use, and calcium use.







Conclusions: A normal testosterone level was protective of bone mineral density in HIV-infected patients compared to the control population. At the L-spine, HIV patients with low testosterone had a lower bone mineral density (p < 0.05). Treatment of osteopenia/osteoporosis with testosterone in HIV patients needs further evaluation.



BACKGROUND



Prevalence of osteoporosis in HIV-uninfected hypogonadal men is reported to be 12.3% vs. 6.0% in men with normal testosterone levels1.



Among patients enrolled in the Study to Understand the Natural History of HIV and AIDS (SUN), 52% had osteopenia and 10% had osteoporosis. Among these patients 78% were men, 25% were black, and 80% of patients received antiretrovirals (ART)2.



Up to 70% of treatment-naive HIV-infected men are reported to have low free testosterone3.



Whether an isolated HIV-related hypogonadism interaction plays a role in developing osteopenia/osteoporosis is unknown.



It remains unclear how HIV itself or other known attributable factors (such as age, sex, race, duration of HIV, ART, hypogonadism, etc.) lead to the development of osteopenia/osteoporosis.



There is a renewed interest in the pathogenesis, diagnosis, and management of osteoporosis in this population.



HYPOTHESIS

We hypothesize that patients with HIV with low free testosterone levels have lower T-scores.


METHODS/STATISTICAL ANALYSIS


A retrospective chart review was performed on two groups: 80 HIV-infected men and 154 HIVuninfected men (see Table 1 for epidemiologic characteristics in each population).


HIV-specific information was obtained in those men who were HIV-infected with low and normal testosterone (see Table 2).



An analysis of covariance was done controlling for the following factors: age, race, BMI, smoking, and use of prednisone, heroin, cocaine, alcohol, methadone, androgen, alpha reductase inhibitor, phosphodiesterase inhibitor, bisphosphanate, and calcium (see Figs 1 – 3, Table 4).



The serum free testosterone (FT) levels were measured by Quest diagnostics (using dialysis method Wood Dale II). The normal FT ranges 35 – 210 pg/mL (see Fig 4 for free vs. total testosterone correlations in HIV-infected and HIV-uninfected patients).




REFERENCES

1. Fink H.A., Ewing S.K., Orwoll E.S., et al. Association of Testosterone and Estradiol Deficiency with Osteoporosis and Rapid Bone Loss in Older Men. The Journal of Clinical Endocrinology and Metabolism 2006; 91(10): 3908 – 3915.

2. Calza L., Tampellini L., Chiodo F., et al. Bone Mass Loss in Patients with

HIV Type 1 Infection. Infectious Diseases in Clinical Practice 2007; 15(3):

160 – 166.

3.Wunder D.M., Bersinger N.A., Furrer H., et al. Hypogonadism in HIV 1-infected men is common and does not resolve during antiretroviral therapy. Antiviral Therapy 2007; 12:261 – 265.