PASC is interested to define the baseline fracture rate and bone mineral density loss in the HIV population, how this differs from fracture rate and BMD loss in the broader population with age, and how a specific intervention (scanning and medication) can improve bone loss outcomes. Ideally the main outcome measure should be fracture rate. In the absence of this information change in BMD as measured by a or Z-score is an acceptable surrogate marker for the risk of MTF. References Australian Institute of Health and Welfare 2008. A picture of osteoporosis in Australia. Arthritis Australian Institute of Health and Welfare Use of health services for arthritis and osteoporosis. Arthritis series no. 14. Cat. no. PHE 130. Canberra: AIHW. Australian Institute of Health and Welfare 2010b. Medication use for arthritis and osteoporosis. Cat. no. PHE 121. Canberra: AIHW. Australian Institute of Health and Welfare 2011. A snapshot of osteoporosis in Australia 2011. Arthritis series no. 15. Cat. no. PHE 137. Canberra: AIHW. Australian Medicines Handbook (AMH), URL: [accessed March 2012] Bedimo R, Zhang S, Dreschler H, Tebas P, Mallouf N. Risk of osteoporotic fractures associated with cumulative exposure to tenofovir and other antiretroviral agents. In: Program and abstracts of the 13th International Workshop on Adverse Drug Reactions and Comorbidities (Rome). London: International Medical Press, 2011. Bolland MJ, et al Low Body Weight Mediates the relationship between HIV infection and Low Bone Mineral Density: A Meta-Analysis. Journal of Clinical Endocrinology and Metabolism 92 (12) 4522-4528 2007 Bolland MJ, Wang TKM, Grey A et al 2011. Stable bone density in HAART-treated individuals with HIV: a meta-analysis. J Clin Endocrinol Metab 96:2721-2731. Brown TT et al. Antiretroviral therapy and the prevalence of osteopenia and osteoporosis: a review. AIDS 2006:20(17):2165-74. Center JR, D, Nguyen TV & Eisman JA 2007. Risk of subsequent fracture after low-trauma fracture in men and women. Journal of American Medical Association 297:387–94. trial.
Monitor plasma calcium concentration in renal impairment; if necessary, reduce dosage or stop. Vitamin D; Hyperphosphataemia (Vitamin D only) IV skin necrosis (extravasation), irritation Vitamin D; hypercalcaemia, and cardiovascular damage may occur because of ectopic calcification. All information obtained from the Australian Medicines Handbook (AMH), January 2012 or the NHMRC clinical guidelines 2010
60 mg/10 mL injection, 1 x 10 mL vial 3341 Hypercalcaemia of malignancy refractory to anti-neoplastic therapy N/A 90 mg 3341 Hypercalcaemia of malignancy refractory to anti-neoplastic therapy N/A 3342 Multiple myeloma 3343 Bone metastases from breast cancer 4 vials powder 15 mg + 4 ampoules solvent 5 ml 3341 Treatment of hypercalcaemia of malignancy refractory to anti-neoplastic therapy N/A 2 vials powder 30 mg + 2 ampoules solvent 10 ml 3256 disease of bone N/A Concentrated injection 15 mg in 5 mL N/R 3256 Treatment of hypercalcaemia of malignancy refractory to anti-neoplastic therapy Symptomatic Paget disease of bone N/A Concentrated injection 30 mg in 10 mL N/R 3256 Treatment of hypercalcaemia of malignancy refractory to anti-neoplastic therapy Symptomatic Paget disease of bone N/A Concentrated injection 60 mg in 10 mL N/R 3256 Treatment of hypercalcaemia of malignancy refractory to anti-neoplastic therapy Symptomatic Paget disease of bone N/A Concentrated injection 90 mg in 10 mL N/R Treatment of hypercalcaemia of malignancy refractory to anti-neoplastic therapy N/A 90 mg injection [1 x 90 mg vial] (&) inert substance diluent [1 x 10 mL ampoule], 1 pack N/R Hypercalcaemia of malignancy refractory to anti-neoplastic therapy Multiple myeloma Bone metastases from breast cancer N/A
30 mg injection [2 x 30 mg vials] (&) inert substance diluent [2 x 10 mL ampoules], 1 pack N/R 3256 Treatment of hypercalcaemia of malignancy refractory to anti-neoplastic therapy Symptomatic Paget disease of bone N/A 15 mg injection [4 x 15 mg vials] (&) inert substance diluent [4 x 5 mL ampoules] N/R 3256 Treatment of hypercalcaemia of malignancy refractory to anti-neoplastic therapy Symptomatic Paget disease of bone N/A Clodronate sodium 400 mg N/R Maintenance treatment of hypercalcaemia of malignancy refractory to anti-neoplastic therapy; Multiple myeloma Bone metastases from breast cancer N/A 800 mg N/R Maintenance treatment of hypercalcaemia of malignancy refractory to anti-neoplastic therapy; Multiple myeloma Bone metastases from breast cancer N/A -Tiludronate Disodium 200 mg 3256 Symptomatic Paget disease of bone N/A -Ibandronic Acid 6 mg/6 mL injection, 1 x 6 mL vial 3343 Bone metastases from breast cancer N/A 50 mg N/R Bone metastases from breast cancer N/A Zoledronic Acid 4 mg/5 mL injection, 1 x 5 mL vial N/R 3342 3343 4052 3341 Multiple myeloma Bone metastases from breast cancer Bone metastases from castration-resistant prostate cancer Treatment of hypercalcaemia of malignancy refractory to anti-neoplastic therapy N/A 4100 Corticosteroid-induced osteoporosis in a patient currently on (prednisolone or equivalent) corticosteroid therapy. ≤-1.5