Tenofovir-associated severe bone pain: I cannot walk!

Two adult patients living with AIDS presented with severe bone pain associated with tenofovir (TDF) use. Both were unable to walk without assistance and were severely restricted in their movement due to the bone pain. Both had mild renal impairment, Fanconi syndrome, and bone mineral density (BMD) loss. Bone pain and inability to walk were reversible with the cessation of TDF and supplementation with Vitamin D(3), calcium, and phosphate. These cases appear to be examples of the severity of BMD loss associated with TDF use and suggest not only attention to renal function with TDF use, but also monitoring of alkaline phosphatase (bone fraction) and plasma phosphorus as indicators of BMD loss.