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, help you move, and protect some of your organs from injury. Bones also store minerals such as calcium and phosphorous and make many of the cells that circulate in your blood (e.g., red blood cells, white blood cells, platelets).

Bones are constantly changing throughout 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. As a result, the bones become lighter and weaker, which puts 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 or a fracture is the first sign of weakened bones. This weakness is often referred to as low bone mass or low bone density. Bone mass or bone density refers to how much internal bone structure is in a given section of bone. For example, more dense bone 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 people living with HIV getting older. People living with HIV are more likely to experience three bone conditions: osteopenia, osteoporosis, and osteonecrosis.

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 have a bone density test. If you do learn you have osteopenia, there are things you can do to stop it and possibly even reverse it (see the Physical Activity and Diet sections below).

Osteopenia can lead to a more serious condition called osteoporosis (see below), but having osteopenia does not mean 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 replaced causes lower bone mineral 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. Sometimes bones break without an injury.

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 loss:

Risk Factors You Can Control

• Diet: Getting too little calcium and vitamin D
• Physical inactivity: Not being physically active, especially not doing weight-bearing or resistance activities
• Low 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
• Use of certain medicines: Long-term use of medicines including Depo-Provera (an injectable form of birth control), glucocorticosteroids (drugs such as prednisone and cortisone), thyroid hormones, anticonvulsants (anti-seizure medications), heparin (blood thinner), pentamidine (antibiotic), and ketoconazole (anti-fungal)

Risk Factors You Cannot Control

• Age: Your chances of getting osteoporosis increase with age
• Gender: Women have a greater chance of getting osteoporosis than 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.
• Family history: having a parent with osteoporosis, especially a mother or father who has had a hip fracture, increases your risk of bone loss