Treatment Issues for Women
When we're young, our bones get stronger as we grow. At some point, perhaps around age 30, we stop building bone. Our bones get weaker as we get older, and women in general experience bone loss at a much higher rate than men.
Even without HIV, you're at higher risk of losing bone quickly if you are: female, over age 50, are in or have been through menopause, are white or Asian, slender, or have a family history of osteoporosis. Bone loss also happens faster if you smoke, drink alcohol or a lot of caffeine, use corticosteroids like prednisone, or don't exercise. Our bodies need both calcium and vitamin D to build bone.
People with HIV seem to experience bone loss more often than people without HIV. We don't know whether this is because of the disease itself, treatments, or a combination of both. What we do know is that being female and having HIV are both risk factors for bone loss. Recently, two bone conditions have been seen in people living with HIV. Osteoporosis (sometimes called brittle bones) is a loss of the mineral in bones, which makes them more porous and likely to fracture. Osteonecrosis refers to the death of bone, due to a lack of blood supply to the bone.
You can have osteoporosis without any symptoms, but there are tests to diagnose it. This is very important if you're at high risk (many positive women are) or if you've been experiencing bone pain. A special X-ray, called a DEXA scan, is used to measure bone mineral density. It's also important to ask your doctor to check your hormone levels, since estrogen deficiency can increase your risk of bone loss.
There are several things you can do to slow down bone loss: stop smoking, reduce or stop drinking alcohol and caffeine, and increase your intake of vitamin D and calcium (by using calcium supplements and/or eating foods like leafy green vegetables and dairy products). Regular exercise that requires you to bear weight, such as walking or lifting weights, also helps strengthen your bones.
Drugs called biphosphonates -- Fosamax (alendronate) and Actonel (risedronate) -- are often used to prevent and treat bone density loss in postmenopausal women. These drugs haven't been studied in pre-menopausal women with bone loss, but some healthcare providers offer them to positive women who have low bone density. Studies are currently underway to evaluate the use of these drugs in positive women. Evista (raloxifene) is a selective estrogen receptor modulator (SERM) that may offer bone and heart benefit for women with low estrogen, without the increased risk of breast or endometrial cancer.
This article was provided by AIDS Community Research Initiative of America. Visit ACRIA's website to find out more about their activities, publications and services.