Bone Health and HIV/AIDS

Table of Contents

• The Importance of Healthy Bones
• Bone Loss and HIV
• Risk Factors
• How to Know if You Have Bone Problems
• Diet and Healthy Bones
• Physical Activity and Healthy Bones
• Drugs to Treat Osteoporosis
• Protect Your Bones

The Importance of Healthy Bones

Bones play many important roles in your body. They support you and help you move. They protect your brain, heart, and other organs from injury. Bones also store minerals such as calcium and phosphorous.

Bones are living tissue and change during your life. Every day, your body removes old bone and adds new bone in its place. In young people, more bone is added than removed. After age 30, more bone is removed than added. This makes the bones lighter and more fragile, putting them at greater risk for injury.

Many people have weak bones and do not know it. This is because bone loss often happens over a long period of time and does not hurt. For many people, a broken bone is the first sign that their bones have weakened. Bone weakness is often discussed in terms of low bone mass or low bone density. Bone mass or bone density refers to how much internal bone structure is in a given stretch of bone. More dense bone, for example, has more calcium and phosphorus -- two key minerals that make up bone -- per square inch of bone.

Bone Loss and HIV

Bone loss and weakened bones occur more often in people living with HIV (HIV+). Experts are not exactly sure why. It could be due to HIV itself, HIV drugs, or HIV+ people getting older. There are three bone conditions which HIV+ people are more likely to get:

Osteopenia

Osteopenia is caused by a loss of bone minerals that leads to lower-than-normal bone density. Most often, osteopenia has no symptoms. The only way to know if you have this condition is to get a bone density test done. If you do find you have osteopenia, there are things you can do (see below) to stop it and possibly even reverse it.

Having osteopenia does not mean that you will definitely develop osteoporosis; however, it does mean that you are more likely to develop it. Although bone loss with osteopenia is generally less severe than with osteoporosis, it does indicate that bones are weaker and may be more likely to break.

Osteoporosis

Osteoporosis is a more serious condition than osteopenia, and refers to a loss of bone density and bone mass. Over time, breaking down more bone than is put back causes lower bone density, also called bone mineral density, which means there are lower-than-normal levels of minerals in the bones. Bones become weak and are more likely to break. People with osteoporosis most often break bones in the wrist, spine, and hip.

Osteonecrosis (Avascular Necrosis)

Osteonecrosis means bone death. It is caused by a loss of blood supply to the bone. Osteonecrosis may cause pain at the affected joint. It usually affects the head of the femur, the ball-shaped part of the thigh bone that connects it to the hip.

Risk Factors

In addition to HIV and HIV drugs, there are other things can put you at risk for bone disease:

Risk Factors You Can Control

• Diet: Getting too little calcium and vitamin D
• Physical activity: Not being physically active, especially not doing weight-bearing or resistance activities
• Body weight: Being too thin
• Tobacco use: Smoking, using snuff, or chewing tobacco
• Alcohol and coffee intake: Drinking a lot of alcohol and/or caffeine
• Testosterone levels: Low testosterone levels in men
• Menopause: Women lose bone due to hormone changes that happen after menopause. While hormone replacement therapy is no longer routinely recommended, it is an effective therapy for bone loss that does not respond to other treatments.
• Use of certain medicines: Long-term use of medicines including glucocorticosteroids (drugs such as prednisone and cortisone), thyroid hormones, anticonvulsants (anti-seizure medications), heparin, pentamidine, and ketoconazole

Risk Factors You Cannot Control

• Age: Your chances of getting osteoporosis increase as you get older
• Gender: Women have a greater chance of getting osteoporosis
• Ethnicity: Mexican American, non-Hispanic white, and Asian women are at higher risk; African-American women are also at risk, but less so