Bone Health and HIV/AIDS
July 28, 2015
Osteoporosis and Osteopenia
Bone mineral density (BMD) tests are the only way to find out if you have osteoporosis or osteopenia. The most widely used BMD test is a DEXA (Dual Energy X-ray Absorptiometry) scan. The DEXA scan is a kind of x-ray, and is an easy and painless test that takes about 15 minutes.
Osteonecrosis can cause pain in the joints, usually in the hip area. At first the pain may only occur when you put weight on the joint. In more severe cases the pain can be constant. An MRI (magnetic resonance imaging) scan can spot early stages. X-rays and other scans can detect advanced osteonecrosis.
Guidelines for Bone Care
The World Health Organization (WHO) recently released new guidelines for the management of bone health among people living with HIV. The guidelines recommend that all pre-menopausal women living with HIV who are 40 years old or older have their risk of fracture measured using the Fracture Risk Assessment Tool (FRAX) without a DEXA scan. This assessment looks at risk factors for fracture (e.g., age, smoking, family history of fracture, etc.) and calculates a probability of future fracture.
The guidelines also suggest that DEXA scans be conducted for all postmenopausal women living with HIV, HIV+ people with a history of fragility fracture, HIV+ people receiving chronic glucocorticoid treatment, and people living with HIV who have a high risk of falls.
Lastly, the guidelines recommend that people living with HIV who are at risk for bone loss and/or fracture have their HIV treatment regimens adjusted so that they do not contain tenofovir or boosted protease inhibitors.
Even though you cannot control all of the things that lead to bone disease, you can control your diet. The mineral calcium makes up a large part of your bones. This means that if you do not get enough calcium in your diet, your bones may get weaker.
Calcium is found naturally in some foods, and it is added to others. Some foods that contain calcium are:
Some people living with HIV still need to take calcium pills every day even if their diet includes foods with calcium in them. A registered dietitian or other trained health care provider can help you decide if you should take calcium supplements. If you do take calcium supplements, it may be a good idea to take calcium pills with vitamin D in them, since your body cannot use calcium without vitamin D. According to the Office of Dietary Supplements at the National Institutes of Health in the US, the recommended dietary allowances are:
Talk to your health care provider before taking any supplements and do not take more than these amounts unless instructed to by your health care provider.
If you do not have joint pain, it is important to be physically active on a regular basis. When you exercise your muscles pull against your bones, which helps keep your bones healthy and strong. The best kind of physical activities to keep your bones strong are activities that use weight or resistance such as:
If you cannot do high-impact weight-bearing activities, try lower-impact ones. For example, try walking or stair climbing instead of jogging. If you have not exercised regularly for a while, check with your health care provider before beginning a new exercise program.
Once you have your health care provider’s approval, start your exercise routine slowly. Every week or two, make your routine five minutes longer. In the end, it is recommended that you do 150 minutes of moderate-level physical activity each week (e.g., five 30-minute workouts).
Diet and exercise are best for keeping bone loss from occurring. They can also be helpful if you already have osteopenia or osteoporosis, but in some cases, your health care provider may also recommend treatment with medication.
Make sure to ask your health care provider about how to take the medication, possible side effects, and whether there are any interactions with HIV drugs you take. Some of the osteoporosis medications that are commonly used include:
These drugs are widely used to treat and prevent osteoporosis. They include:
It is important to get enough calcium and vitamin D when you are taking a bisphosphonate.
Selective Estrogen Receptor Modulators (SERMs)
Evista (raloxifene) is in a class of osteoporosis drugs called SERMs. Evista was developed to work like estrogen therapy, but with fewer side effects.
Denosumab (Prolia or Xgeva) is given as a shot (injection), and is used to treat postmenopausal women at high risk for fracture. It works by stopping the development of cells that remove bone.
It is important that women living with HIV, especially those who have experienced menopause, pay careful attention to their bone health. Speak to your health care provider and follow these steps to help protect your bones:
This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with TheBody.com to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from TheBody.com or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.
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