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Bone and Joint Problems

Part of An HIVer's Guide to Metabolic Complications

December 2005

You might think that your bones stay pretty much the same once you become an adult, but that isn't the case. In fact, each one of your bones is in a constant state of change and renewal; experts say that your entire skeleton gets replaced every 10 to 20 years.

Some of your bone cells make the materials that will become bone, while other bone cells eat up and remodel those materials.

Occasionally, though, something goes wrong with this process of bone creation and renewal. This is when bone problems occur.

What Causes Bone Problems?

Some experts believe that HIV itself may affect bones in ways that we don't yet understand. In addition, you may be more likely to develop bone problems if you are:


  • a woman (especially if you've gone through menopause or have low levels of estrogen)

  • older (bone mass peaks at around age 25, after which bones become less dense)

  • white

  • underweight

  • not getting much exercise

  • a smoker

  • a heavy alcohol drinker

  • someone who has used corticosteroids (such as Prednisone or Cortisone), either as pills or through injections

  • extremely fond of caffeine (too much coffee, tea, cola, chocolate, etc.)

  • part of a family with a history of bone problems

Types of Bone Problems

Osteonecrosis (also called avascular necrosis) is a condition in which bone tissue dies because not enough blood is being supplied to the bone, usually because of damage to blood vessels in the area. It usually happens to bone tissue about the hip joints, although it can occur in bone tissue near other joints.

Osteoporosis is a condition in which your bones become smaller and less dense, which may make them more likely to break.

Osteopenia is like osteoporosis, only less severe.

Are HIV Meds to Blame?

Researchers are still trying to figure out how much of a role HIV meds play in bone problems. Most of what we know suggests that, even if HIV meds do play a role, the factors listed above are more important.

We know that some bone problems, like osteonecrosis and osteopenia, have occurred more often in HIV-positive people over the last 10 years, especially in people taking protease inhibitors. However, it's not clear whether there's a direct cause-and-effect relationship. Since people with HIV are now living longer, it's possible that the long-term effects of HIV, rather than HIV meds, are to blame. Some research has shown that HIV-positive people are at a higher risk for bone problems than HIV-negative people, even if they've never taken HIV meds.

Still, there are early signs that some HIV meds, including Viread and Zerit, may at least have some effect on people's bones. Hopefully, researchers will take a closer look at these possible links in the future.

What Can You Do?

The best weapon against bone problems is to keep them from happening in the first place. There are a few common-sense things you can do if you and your doctor think you may be at risk for bone problems:


Calcium is one of the key ingredients in bones, so it should not come as a surprise that calcium-rich foods -- like milk, cheese, yogurt and other dairy products -- are an essential part of a bone-healthy diet. Besides dairy, a growing number of foods are "calcium-fortified," including some breads and orange juice.

Calcium supplements can also help. The daily recommended intake of calcium is 1,000 mg, but you should talk to your doctor or a nutritionist to find the dosage that is right for you before you start taking a supplement. Some calcium supplements can reduce the strength of HIV meds. (Tums, for example, can weaken Reyataz.)

Vitamin D

This vitamin helps your body absorb calcium. Experts recommend you take between 400 and 800 IU (international units) per day. Many over-the-counter supplements contain both calcium and vitamin D.


Phosphorous is also essential in bones, so make sure you get enough. Dairy products often have phosphorous in them, as do beans and peanuts. You can also find supplements that contain phosphorous.


Regular exercise -- especially the kind that involves weights or resistance -- can help prevent a bone fracture by strengthening the muscles that support the bones. Walking, jogging, stair-climbing and weight-lifting can all be helpful. And we're not talking about once in a while, either; consistent exercise is the key to healthy bones!

Prescription Medications

Several medications have been found to make bones denser. These include Fosamax and Actonel; both are approved for use in women and men with certain types of osteopenia. Fosamax, in particular, has been found to be effective in studies of HIV-positive people who have reduced bone density. If Fosamax or Actonel don't work, your doctor can recommend other prescription medications.

Hormone Replacement

Estrogen and testosterone, the main female and male hormones, appear to help keep bones healthy. But as we get older, production of these hormones begins to drop. This is especially a concern for women who have been through menopause. If your doctor finds that your hormone levels are low, the two of you should discuss the risks and benefits of hormone replacement therapy.

Copyright © 2005 Body Health Resources Foundation. All rights reserved.

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This article was provided by Body Health Resources Foundation. It is a part of the publication An HIVer's Guide to Metabolic Complications.