Carr A, Kerr SJ, Richardson R, et al. - In HIV-infected, osteopenic adults, greater efficacy at increasing BMD over 24 months was seen with zoledronic acid (ZOL) 5 mg annually vs tenofovir disoproxil fumarate (TDF) switching, the authors examined if ZOL effects would endure without further infusions. They compared candidates randomized to ZOL 5 mg at baseline and month 12 (and to continue TDF) or to switch TDF (without receiving ZOL) with regard to changes in left hip and spine BMD over 36 months. Comparisons were also made for changes in the plasma bone turnover markers and if BMD changes at month 36 were predicted by C-terminal telopeptide of type 1 collagen and procollagen type 1 N propeptide (P1NP) changes at month 3. The results of this study revealed an inverse correlation of only percent changes in P1NP at month 3 with BMD changes at month 36. Sustained BMD increases through month 36 were offered by two infusions of ZOL (with ongoing TDF); these increases continued to be greater than with TDF switching. Mean hip and spine BMD change from baseline were stable and stayed greater with ZOL at Month 36 than with TDF switching, even without receiving ZOL after month 12.