BONE COMPLICATIONS IN HIV: Edited by Patrick W.G. Mallon and Todd T. BrownTenofovir and bone healthGrant, Philip M.a; Cotter, Aoife G.b,cAuthor Information aDivision of Infectious Diseases; Department of Medicine; Stanford University, Palo Alto, CA, USA bHIV Molecular Research Group, School of Medicine & Medical Science, University College Dublin cDepartment of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland Correspondence to Philip M. Grant, Division of Infectious Diseases and Geographic Medicine, Stanford University, 300 Pasteur Drive, Room S-101, Stanford, CA 94305-5107, USA. Tel: +1 650 723 9001; fax: +1 650 568 1708; e-mail: [email protected] Current Opinion in HIV and AIDS: May 2016 - Volume 11 - Issue 3 - p 326-332 doi: 10.1097/COH.0000000000000248 Buy Metrics Abstract Purpose of review With continued improvements to the antiviral efficacy and tolerability of antiretroviral therapy, long-term safety of antiretroviral therapy has become paramount. Low bone mineral density and fragility fractures are more common in HIV-infected individuals than in the general population. The aims of this review are to describe potential mechanisms underlying the adverse effects of tenofovir on bone, clinical studies of tenofovir disoproxil fumarate (TDF) and bone, and more recent bone data on tenofovir alafenamide. Recent finding Several studies have demonstrated an approximately 1–3% greater bone mineral density loss with TDF compared with other agents. Recent studies with tenofovir alafenamide have shown improved bone (and renal) safety with similar virologic efficacy when compared to TDF. Summary Given these findings, TDF-containing regimens may be gradually replaced with non-TDF containing regimens for the treatment of HIV infection, especially in those at higher risk for fragility fracture. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.