Facts about HIV and osteoporosis

Does HIV itself contribute to bone changes?

Yes, it does. Bone is constantly being renewed, which keeps the skeleton strong. When old bone is removed and new bone is replaced in the same place, it is called bone remodeling. This repairs skeletal damage and prevents the build-up of old, brittle bones.

With osteoporosis, the balance between bone formation and bone loss shifts, so more and more bone is lost but not replaced. As a result, the bone becomes weak and more likely to break over time.

HIV can directly infect cells that remove old bone. HIV can also increase the activity of bone-removing cells and signal the body to make more bone-removing cells, which leads to bone loss.

Even with effective treatment, HIV proteins remain in the body and can signal the body to make fewer bone-forming cells or disrupt how well they make new bone, tipping the balance toward less new bone formation.

HIV also disrupts the body’s immune system, which improves but does not disappear completely with treatment that controls the virus. The low levels of chronic inflammation associated with HIV affect the cells that remove bone, which also leads to bone loss over time.

How does HIV medication contribute to bone changes and osteoporosis risk?

Treatment of HIV with antiretroviral therapy (ART) it has led to huge health benefits for people with HIV, but it also affects bones.

When a person starts ART for the first time, along with the reduction of circulating HIV levels in the blood to undetectable levels, the immune system quickly returns to recovery. This process leads to increased inflammation throughout the body. For about a year after starting any ART regimen, this inflammation leads to bone loss, with more bone being removed than being formed at the same time.

Some HIV drugs cause more bone loss than others. Switching to a newer drug formulation with fewer bone-related side effects has been shown to improve bone density.

Are there other factors that contribute to bone loss in people with HIV?

Certain medical conditions that are more common in people with HIV, such as chronic liver or kidney disease and early menopause (before age 45), put people at higher risk for osteoporosis.

In addition, certain behaviors such as smoking and alcohol use have been linked to osteoporosis and may be more common in people with HIV.

Older age is a risk factor for osteoporosis, especially for women. While it is known that people lose bone and have an increased risk for osteoporosis as they age, this is especially true for people with HIV who are not only at higher risk for osteoporosis than people without HIV, but may also develop osteoporosis at a younger age.

How can people with HIV prevent bone loss?

There are many ways people can maintain their bone health and prevent bone loss, and all of them apply to people with HIV. Getting the recommended amount of calcium in your diet is important to keep your bones strong. Because the body’s ability to absorb calcium decreases as they age, older adults need higher amounts of dietary calcium.

Vitamin D also plays a key role in bone health. It helps the body absorb calcium from food, helps the skeleton to regenerate and mineralize, and helps keep muscles strong to reduce the risk of falls. People with low vitamin D levels may need to take a vitamin D supplement and a calcium supplement to make sure they get enough of both.

Quitting smoking and limiting alcohol intake are also important for maintaining both overall and bone health.

Hormone therapy (HT) with estrogen after menopause or for trans women has been shown to improve bone mineral density, while less is known about the bone effects of HT with testosterone for trans men.

Exercise plays a vital role in bone health and the prevention of osteoporosis. Bones and muscles respond and strengthen when stressed by weight-bearing exercises (such as running or dancing). Regular exercise can help build and maintain bone and muscle strength and improve balance to prevent falls. Because osteoporosis is more common in people with HIV, they may be more likely to suffer a serious injury after a fall, such as a fracture. Taking safety precautions at home, such as removing trip hazards, ensuring good lighting, making sure your glasses have the right prescription and fit, and wearing comfortable flat shoes are all ways to prevent falls.

Tell your healthcare provider if you feel dizzy or have had a fall, and discuss whether any of your medications may be playing a role in your risk of falling, especially if you take many different types of medications. Also ask your HCP if your HIV medications are the most bone-friendly or if there are other options for you that have fewer bone side effects.

Read: 6 Ways to Strengthen Your Musculoskeletal System >>

Are there specific recommendations for bone health screening for people with HIV?

Because people living with HIV are at higher risk for osteoporosis and fractures compared to people not living with HIV, there are specific recommendations for bone health screening for their routine health care.

The most common way to check for osteoporosis is to use a dual-energy x-ray absorptiometry (DEXA) scan, which measures bone density levels. The results can also be used to help predict a person’s risk of having a serious fracture.

A DEXA scan is recommended for all women with HIV after menopause and for all women with HIV from the age of 50.

People with HIV who take certain medications such as steroids, have a history of fracture, or have conditions that put them at high risk for osteoporosis and fracture should have a DEXA scan at an earlier age.