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Nov 12, 2009

I have been on Reyataz, Norvir and Truvada for a little over 2 years. I took a Dexa Scan. My id doc said I have osteopenia and probably should start Fosamax or Boniva in about 2 years. I have a history of osteoporosis in my family (mother). I have been tested for Vitamin D level and it is fine according to doctor. I have some injuries over the years, fractures, dislocations, etc which are giving me some pain in the last few months. When I am looking at the copy of my Dexa Scan report, what are the levels and nonmenclature I am looking for that would indicate a need to start Boniva or Fosamax now as opposed to in 2 years from now? Are there additional tests I should take-i.e. testosterone level, or others in lieu of my diagnosis? What type of specialist would I review this diagnosis of osteopenia, with? Is Truvada the cause? Should I consider a switch of medical regimens? I am doing fine with this- undetectable, cd4 is 850. thanks

Response from Dr. Henry

Definition of osteoporosis from wikipedia is pasted below:

Dual energy X-ray absorptiometry

Dual energy X-ray absorptiometry (DXA, formerly DEXA) is considered the gold standard for the diagnosis of osteoporosis. Osteoporosis is diagnosed when the bone mineral density is less than or equal to 2.5 standard deviations below that of a young adult reference population. This is translated as a T-score. The World Health Organization has established the following diagnostic guidelines:[1][12]

* T-score -1.0 or greater is "normal" * T-score between -1.0 and -2.5 is "low bone mass" (or "osteopenia") * T-score -2.5 or below is osteoporosis

When there has also been an osteoporotic fracture (also termed "low trauma-fracture" or "fragility fracture"), defined as one that occurs as a result of a fall from a standing height, the term "severe or established" osteoporosis is used.[1]

The International Society for Clinical Densitometry takes the position that a diagnosis of osteoporosis in men under 50 years of age should not be made on the basis of densitometric criteria alone. It also states that for pre-menopausal women, Z-scores (comparison with age group rather than peak bone mass) rather than T-scores should be used, and that the diagnosis of osteoporosis in such women also should not be made on the basis of densitometric criteria alone.[30]

There are multiple bone sites that can be assessed (LS spine, hip, wrist are common). Seeing an endocrinologist can be helpful to look for other risk factors and discuss pros and cons of treatment. Tenofovir occasionally contributes to bone loss but many other factors can be involved including steroid use, smoking cigarettes, hypogonadism. Once started on a drug such as Fosamax it is unclear when if ever to stop (another great condition for drug companies). KH

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