Boning Up on Bone Health
Growing Evidence Suggests That People With HIV May Be at Risk of Bone-Related Problems
Knowing the risk factors for osteoporosis can help you avoid some of them and may flag a potential problem before it occurs. However, it's entirely possible to have several risk factors and never develop osteoporosis. Many experts believe that the best way to know for sure if there is bone loss is to get a bone scan. A bone scan is a painless, non-invasive procedure that can identify whether you have experienced significant bone loss, whether there is early loss (that may or may not worsen), or whether there is nothing to worry about. A bone scan also provides a baseline against which to compare future results.
Current guidelines recommend measuring BMD in all women and men age 65 and older; in adults 50 and over who have certain risk factors for fracture (such as long-term use of certain medications, smoking and high alcohol intake, or a fragility fracture); and in men and women under the age of 50 if they have a disease or condition associated with bone loss (such as a chronic inflammatory condition or uncontrolled hyperthyroidism). There are currently no guidelines for the use of bone scans in PHAs, but many experts believe that HIV should be added as a risk factor for osteoporosis and that PHAs 50 and over should go for bone scans every few years.
Keep in mind that the BMD results of a scan are only one of several risk factors for fracture and that many people diagnosed with osteoporosis never break a bone. Although not all experts agree on what should be done with the results from a bone scan, there are some things you can do to live well with osteoporosis.
Prevention is the best medicine when it comes to your bone health. And many of the things you can do to prevent osteoporosis also prevent bone loss in people who already have osteopenia or osteoporosis. Basically, you're never too young or too old to start strengthening your bones.
Vitamin D3 and calcium are essential for healthy bones. Almost every part of your body needs calcium to function properly. When you don't get enough, the body takes it from your bones. So, if you aren't getting enough calcium from your diet, you may want to consider supplements. For your body to absorb calcium and other minerals, it needs vitamin D3. The sunshine vitamin is now widely touted due to widespread deficiency among Canadians and its many health benefits. (To find out about the daily recommended amounts, see CATIE's Practical Guide to Nutrition for People Living with HIV, available online and through the CATIE Ordering Centre.)
Exercise makes bones denser and improves posture and balance, especially weight-bearing exercises (such as walking and Tai chi) and those that enhance core stability and strengthen muscles -- all good for preventing falls and fractures. People with severe bone loss should be careful not to overstrain their bones and should check in with a doctor or sports therapist to determine the "right amount" of strain for them.
Do your bones a big favour: Avoid smoking and limit caffeine and alcohol intake.
Take precautions to prevent falls. For example, use salt or sand when the ground is icy, clear stairs, avoid walking on smooth surfaces with stockinged feet, secure loose rugs and cables.
Get checked for secondary causes. Dr. Szabo recommends getting a thorough evaluation for "secondary causes" -- treatable conditions besides HIV that may contribute to the decline in BMD. For example, an overactive parathyroid gland (hyperparathyroidism) or low levels of sex hormones (hypogonadism) can contribute to bone loss. If your testosterone is low, as it is in many HIV-positive men, or if you are a woman with low estrogen due to early menopause or an eating disorder, replacement hormone therapy is available.
Finally, medication may be an option. A class of drugs called bisphosphonates can inhibit the breakdown of bone and, in some cases, increase bone mass. To date, few studies have looked specifically at the effectiveness of these drug treatments in PHAs.
A Balancing Act
Shortly after David Vereschagin's diagnosis of osteoporosis two years ago, his family doctor recommended that he take a combination of calcium, vitamin D3 and the bisphosphonate risedronate (Actonel). Vereschagin found that within two months of starting this regimen, his urine became very cloudy. Wondering if this could be the calcium passing through him, he brought it up with his kidney specialist, who ordered more blood and urine tests and an ultrasound that revealed possible kidney toxicity. So he stopped taking the calcium supplements. A bout of kidney stones while still taking calcium supplements and again shortly after stopping suggested that the supplements may indeed have caused problems for his kidneys.
For Vereschagin, this episode served as a reminder of how interconnected health issues can often be. "Most of us with HIV don't have just one health problem," he says. Dealing with his HIV diagnosis was one hurdle, but "it's an ongoing process. I've had to continually educate myself about HIV, about kidneys, about osteoporosis ... everything is interconnected. You have to find what's right for you."
For most people, there is no reason to avoid calcium supplements or vitamin D3, but if you have a history of kidney stones or other kidney problems, it's worth talking to your doctor to evaluate your situation thoroughly.
It seems that Vereschagin has found what's right for him and his bones. Results of his kidney function tests are stable and his most recent bone scan suggests that his practice of weight training, yoga, avoiding calcium supplements and taking risedronate is working: It showed a five to six percent increase in spinal bone density. Also, he has had no further problems from kidney stones since that last episode. So he's set aside his anxiety and continues to exercise, with a renewed confidence that he's got the backbone to get him through his workouts. Score one for empowered, holistic living.
This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication The Positive Side. Visit CATIE's Web site to find out more about their activities, publications and services.
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