Bone Antiresorptive Therapy With Antiretroviral Initiation (BATARI) Pilot Trial

Inclusion Criteria: * Documented HIV-1 infection * Adult (aged \>18 years or as per local guidelines) * Premenopausal, if female * Antiretroviral-naïve * Starting first-line ART including tenofovir/emtricitabine with either efavirenz (co-formulated as Atripla®) or elvitegravir, cobicistat (co-formulated as Stribild®) * Low (\<10%) ten-year fracture risk as assessed by the FRAX score validated for Canadian populations Exclusion Criteria: * Presence of established osteoporosis at baseline as determined by BMD measurement * Prior or current use of any bone anti-resorptive therapy (eg. bisphosphonate, estrogens with the exception of oral contraceptive pills, etc.) * Inability to communicate in English * Creatinine clearance \<35 mL/min (using Cockcroft-Gault formula) * Hypersensitivity to alendronate, other bisphosphonates, or any component of the formulation * Hypocalcemia * Abnormalities of the esophagus which delay esophageal emptying such as stricture or achalasia * Inability to stand or sit upright for at least 30 minutes * Pregnancy, active plans to become pregnant, or lactation