Hi, I am taking Reyataz, Norvir and Truvada, age 53, on meds for 20 months. I have read that Truvada contributes to bone loss and that after 1 year what ever bone loss I will experience from Truvada, has taken place and does not get much worse. Can you shed light on this? I am experiencing some joint pain in my left thumb and elbow-I am a righty and dont use this hand much. I am also experiencing greater pain in my right arm, wrist and elbow. I work on the computer all day which might contribute to this. I have checked this with a surgeon and he says I do not have carpal tunnel and did some physical therapy on it, not much improved though. I also get joint pain in my knees. I did not experience these pains before the meds-could it be the Truvada causing this? Aging? Should I get a bone density test? If a bone denisity test shows bone loss, what would be typical treatment be? Thanks.

Bone loss (osteopenia if mild and osteoporosis if more severe ) is generally asymptomatic for years and would rarely cause the pain that you are experiencing. The rates of bone mineral loss are high in HIV+ patients before starting HIV medications. For a variety of HIV combinations there is an initial loss of bone density but then a stabilization. Usual amounts lost on antiretroviral are modest even with tenofovir. Getting a baseline DEXA to assess bone mineral density is a good idea for many patients. If the bone mineral density is decreased then calcium, vitamin D (often HIV patient have low levels), and sometimes a phosphonate such as alendronate can stablize or reverse the bone mineral loss (also important to address many other factors that can contribute to bone mineral loss such as hormone deficiencies, use of corticosteroids, smoking, alcohol and many others). KH