NDLI: Iatrogenic osteoporosis, bilateral HIP osteonecrosis, and secondary adrenal suppression in an HIV-infected man receiving inhaled corticosteroids and ritonavir-boosted highly active antiretroviral therapy.

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Iatrogenic osteoporosis, bilateral HIP osteonecrosis, and secondary adrenal suppression in an HIV-infected man receiving inhaled corticosteroids and ritonavir-boosted highly active antiretroviral therapy.

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Iatrogenic osteoporosis, bilateral HIP osteonecrosis, and secondary adrenal suppression in an HIV-infected man receiving inhaled corticosteroids and ritonavir-boosted highly active antiretroviral therapy.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Kaviani, Nargess Bukberg, Phillip Manessis, Anastasios Yen, Vincent Young, Iven
Description	Country affiliation: United States Author Affiliation: Kaviani N ( Division of Endocrinology, Diabetes, and Metabolism, North Shore-Long Island Jewish Health System, Lake Success, New York, USA.)
Abstract	OBJECTIVE: To report the first case of severe osteoporosis associated with a vertebral pathologic fracture and osteonecrosis of femoral heads in an HIV-infected man receiving inhaled corticosteroids and ritonavir-boosted antiretroviral therapy. METHODS: We describe an HIV-infected man with severe osteoporosis, bilateral hip osteonecrosis, and secondary adrenal suppression, including detailed clinical, laboratory, and radiographic data, and review the related literature. RESULTS: A 60-year-old man with a 15-year history of HIV infection and a medical history of long-standing bronchiectasis treated with inhaled corticosteroids and hypogonadism treated with testosterone was referred to the endocrinology clinic after experiencing an osteoporotic vertebral fracture. He was taking ritonavir-boosted antiretroviral therapy. Osteonecrosis of both hips was also diagnosed, which required total hip replacement therapy. Laboratory evaluation revealed adrenal insufficiency due to increased effect of exogenous inhaled steroids and no other secondary causes of osteoporosis. A bone densitometry study showed osteoporosis of both hips and the lumbar spine. He was treated with intravenous pamidronate. During treatment, he developed bilateral femoral fractures after minor trauma. CONCLUSIONS: Given the potential for increased serum levels of inhaled corticosteroids in patients taking ritonavir-boosted highly active antiretroviral therapy, attention must be paid to the risk of bone loss in HIV-infected patients taking inhaled corticosteroids. Prescribing calcium and vitamin D supplementation and considering early osteoporosis screening are reasonable measures for this patient population. Interaction between inhaled corticosteroids and ritonavir may increase risk of hypothalamus-pituitary-adrenal axis suppression.
File Format	HTM / HTML
ISSN	1530891X
Issue Number	1
Volume Number	17
e-ISSN	19342403
Journal	Endocrine Practice
Language	English
Publisher	American Association of Clinical Endocrinologists
Publisher Date	2011-01-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Endocrinology Adrenal Cortex Hormones Adverse Effects Adrenal Insufficiency Chemically Induced Antiretroviral Therapy, Highly Active Hiv Infections Drug Therapy Osteonecrosis Osteoporosis Ritonavir Therapeutic Use Administration, Inhalation Administration & Dosage Humans Male Middle Aged Case Reports Journal Article
Content Type	Text
Resource Type	Case study Article
Subject	Endocrinology, Diabetes and Metabolism Endocrinology

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