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Related Experiment Video

Updated: Jun 16, 2026

Semiautomated Longitudinal Microcomputed Tomography-based Quantitative Structural Analysis of a Nude Rat Osteoporosis-related Vertebral Fracture Model

Semiautomated Longitudinal Microcomputed Tomography-based Quantitative Structural Analysis of a Nude Rat Osteoporosis-related Vertebral Fracture Model

Published on: September 28, 2017

Tenofovir-induced osteomalacia.

D P Wanner¹, A Tyndall, U A Walker

¹Department of Rheumatology, Basle University, Basel, Switzerland.

Clinical and Experimental Rheumatology

|February 13, 2010

Summary

Tenofofovir disoproxil fumarate (TDF) can cause severe bone problems like fractures and pain due to kidney damage. This rare side effect, Fanconi syndrome, requires medical awareness for timely diagnosis in HIV patients.

Area of Science:

Nephrology
Infectious Diseases
Bone Metabolism

Background:

Antiretroviral therapy is crucial for managing HIV infection.
Tenofofovir disoproxil fumarate (TDF) is a commonly used nucleoside reverse transcriptase inhibitor.
Drug-induced nephrotoxicity can manifest with diverse renal tubular dysfunctions.

Observation:

A case of severe skeletal pain, synovial effusions, and multiple fractures in an HIV-infected woman is presented.
The patient developed Fanconi syndrome, characterized by hypophosphatemia and osteomalacia, secondary to TDF treatment.
Symptoms appeared after a prolonged period of TDF exposure.

Findings:

TDF-induced nephrotoxicity involves impaired mitochondrial DNA replication in renal proximal tubules, leading to phosphate wasting.

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Concomitant use of lopinavir/r exacerbated TDF nephrotoxicity by increasing tenofovir serum levels and inhibiting efflux transporter MRP4.

This drug interaction mechanism explains the delayed onset of renal phosphate loss and subsequent bone complications.

Implications:

Clinicians should maintain a high index of suspicion for TDF-associated Fanconi syndrome, even with delayed symptom onset.
Monitoring for hypophosphatemia and bone abnormalities is essential in patients on long-term TDF therapy, especially with protease inhibitor co-administration.
Early recognition and diagnosis are critical to prevent irreversible bone disease and manage TDF-related nephrotoxicity effectively.