Tenofovir-induced pathological neck of femur fractures in Human immunodeficiency virus-positive patients: A report of two cases with review of literature

Long-term antiretroviral therapy (ART), especially tenofovir-based regimens, has been associated with renal tubular dysfunction and reduced bone mineral density. These adverse effects may culminate in pathological fractures, even in the absence of trauma. We report two cases of human immunodeficiency virus-positive patients on prolonged tenofovir-based regimens who presented with neck of femur fractures. Laboratory tests indicated tenofovir-induced nephropathy and proximal renal tubular dysfunction (Fanconi syndrome). Dual-energy X-ray absorptiometry scans confirmed osteopenia. One patient underwent unilateral bipolar hemiarthroplasty, while the other patient was treated conservatively. Both patients were switched to tenofovir-sparing ART regimens and received phosphate, calcium, and vitamin D supplementation. Clinical follow-up showed improvement in symptoms and biochemical markers. These cases underscore the need for vigilance regarding bone and renal complications in patients on long-term tenofovir-containing ART.