Ask the Doctor: HIV and Bone Disease

Ask the Doctor: What Is Hepatitis-and-HIV Co-Infection?

Every month, HIV specialist Theresa Mack, M.D., M.P.H. -- an associate medical director at St. Luke's-Roosevelt Hospital's Medical Group in Harlem, N.Y. -- will answer your most pressing HIV/AIDS questions.

Your bones support your entire body and help you move. They protect your brain, heart and other organs from injury, as well as store calcium and phosphorous. And even though people often think of bones as supportive structures, they are actually living tissue.

Every day the body removes old bone and creates new bone in its place. Special bone cells, called osteoclasts, remove old bone tissue. New bone is created by special bone cells called osteoblast cells. As we grow older, the osteoclast cells removes bone quicker than the osteoblast cells can produce it. This makes bones more fragile and weak and can predispose them to fracture.

What Is Bone Disease?

Bone disease is a very general term that describes a wide variety of bone disorders that affect the structure of the bone and/or the strength of the cells that it comprises. Three types of bone disease tend to be most common among people with HIV: osteopenia, osteoporosis and osteonecrosis.

Osteopenia describes the thinning of the bones due to loss of bone minerals. This bone disease does not have any symptoms.

Osteoporosis occurs when the bones are broken down more rapidly than they are replaced. They become brittle and fragile from loss of tissue. Similar to osteopenia, osteoporosis may not have any symptoms. People often do not know they have it until they suffer a fracture.

Osteonecrosis is bone death due to loss of the bone's blood supply. Hip pain when walking is a common complaint. Constant hip pain is treated with a hip replacement rather than pain relievers.

Bone-Disease Risk Factors

People with low body weight or a thin frame tend to be at greater risk of bone disease. Women experience bone disease more often than men, simply because their bones are smaller. Their risk increases during menopause because they lose bone tissue faster as their hormone levels change. Bone disease can also result from inactivity, smoking, excessive alcohol and caffeine use and adverse effects of some medications, such as steroids, antiretrovirals (ARV) and thyroid medicine. People with kidney disease and diabetes may also develop bone disease more often.

People living with HIV develop the same bone diseases that people who do not have HIV get--and for some of the same reasons--though about two to three times more often. More than 50 percent of people living with HIV may have bone disease. Doctors don't know exactly why. The virus itself is a risk factor, as are the ARV medications used to treat it. Importantly, while Whites and Asians who are HIV negative are at a higher risk of bone disease, bone disease is common among African Americans and Latinos living with HIV.

Another reason people with HIV are prone to bone disease is that they are living longer. As the ARV medicines have changed HIV/AIDS from a fatal illness to a chronic one, people with HIV/AIDS are aging and experiencing some of the same bone diseases that older people who don't have HIV develop.

Signs of Bone Disease

Most people who have bone disease don't know it because bone loss generally doesn't hurt and occurs over time. Symptoms may include joint, back and/or hip pain, but you know you have bone disease when you get a fracture that is not due to, say, trauma or a fall.

To find out if you are suffering from bone disease, ask your doctor to conduct blood tests to screen your levels of calcium, phosphorous and vitamin D. Low levels can contribute to unhealthy bones and fractures. All men and women over 50 years of age and living with HIV should obtain a baseline bone mineral density test. Abnormal results can identify osteopenia and osteoporosis. If the results are normal, the bone mineral density test should be repeated every two to five years.

Here's how you can avoid bone disease:

  • Maintain a healthy diet, which includes getting 1,000 milligrams of calcium and 1,000 milligrams of vitamin D daily. A nutritionist can help you get these nutrients in the correct amounts. Too much calcium and vitamin D can lead to other problems.
  • Exercise regularly with weights.
  • Stop smoking.
  • Avoid excessive alcohol and caffeine.

As told to Tomika Anderson, a freelance writer based in Brooklyn, N.Y.