CC BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2021; 62(01): 034-038
DOI: 10.1055/s-0041-1728734
Case Report | Caso Clínico

Proximal Femur Fracture (31-A3.2) Associated with the Use of Tenofovir by an HIV-positive Patient: Case Report

Article in several languages: español | English
Pia Franz Ruiz
1  Equipo de Cadera y Pelvis, Hospital Base de Osorno, Los Lagos, Chile
Marco Poblete Avilez
1  Equipo de Cadera y Pelvis, Hospital Base de Osorno, Los Lagos, Chile
› Author Affiliations


We present the first case report of a human immunodeficiency virus (HIV)-positive adult patient with a fragility fracture of the proximal femur associated with antiretroviral therapy (ART) with tenofovir disoproxil fumarate (TDF) in Chile. Currently, patients diagnosed with HIV start ART early, resulting in more years of exposure to these drugs. The accumulated exposure time to TDF has been associated with a decreased bone mineral density and progressive renal failure, potentially leading to acquired Fanconi syndrome, osteomalacia, and an increased risk of fracture. We present a case of a 44-year-old, HIV-positive man assessed at the emergency room after a fall from standing height which resulted in a proximal femoral pathological fracture. Laboratory findings at admission revealed hypokalemia, hypocalcemia, hypophosphatemia, and hypovitaminosis D. Multidisciplinary management was performed, with TDF discontinuation, ART change, and supplementation with calcium and vitamin D. Closed reduction and fixation with a long cephalomedullary nail was successful, with early motor rehabilitation, functional recovery, and bone consolidation at 12 weeks. Musculoskeletal pain in HIV-positive patients on ART must raise the clinical suspicion of an adverse drug effect; the follow-up of these subjects must include serial monitoring of renal function and serum calcium and phosphorus levels. Screening and suspicion of such complications would enable an early intervention, improving the patients' condition and preventing pathological fractures.

Publication History

Received: 25 May 2020

Accepted: 21 January 2021

Publication Date:
02 June 2021 (online)

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