New Research Suggests Bone Loss More Likely Among Consistent PrEP Users

Osteoporosis bone density loss disease medical infographics

According to new research presented at the Conference on Retroviruses and Opportunistic Infections, people taking tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) drugs specifically for PrEP experienced bone loss.

For many years, TDF has been linked to bone density loss in people using the drug to treat HIV. Bone density loss in HIV-negative patients taking TDF drugs for prevention of the virus has not been studied as widely. This new research, led by Dr. Joseph Chang of Kaiser Permanente Medical Center in Los Angeles, assessed bone density loss in almost 7,700 adults in Southern California who took TDF/FTC for PrEP from 2012 to 2020. Almost all the participants were men, and most were between the ages of 18 and 39. The majority of participants were Latinx, and other races included white, Asian, and Black. 40% of participants had what the researchers define “good adherence” to the drug, meaning their “proportion of days covered” by PrEP was in the 90-100% range. The remainder of participants had “suboptimal adherence” to the drug, or below 90% of the proportion of days covered.

The participants were tested for osteopenia or osteoporosis (bone weakness conditions) after an average follow-up period of 502 days. Researchers indicated that participants with good adherence to PrEP were “significantly more likely to be diagnosed with osteopenia or osteoporosis” compared to those with suboptimal adherence. Over 90% of participants that developed osteopenia or osteoporosis had good adherence to PrEP, while only 9% of participants that developed the bone loss condition(s) had suboptimal adherence. Based on these results, the researchers suggest that future studies should be performed to explore “on-demand or event-drive PrEP” rather than a daily medication.

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