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Osteoporosis is considered a silent disease for good reasons. People rarely have symptoms of this bone disease before a bone crack or fracture occurs.
The word “osteoporosis” literally means “porous bone” because it causes the natural holes in your bones to enlarge, making your bones thinner, more brittle, and more prone to fractures.
The risk of osteoporosis is particularly high for people with HIV. “HIV contributes to bone changes for several reasons,” said Anjali Sharma, MD, MS, a professor and researcher who focuses on HIV in women at the Albert Einstein College of Medicine.
We asked Sharma to list how HIV can affect bone health and what people living with HIV can do to prevent osteoporosis.
Does the HIV virus itself contribute to bone changes?
Yes, it does. The bones are constantly renewed, maintaining a strong skeleton. When old bone tissue is removed and replaced with new bone tissue in the same location, it is called bone remodeling. This repairs skeletal injuries and prevents the formation of old, brittle bone tissue.
In osteoporosis, the balance between bone formation and loss changes, so that more and more bone tissue is lost without being replaced. As a result, bones become weaker and there is a higher risk of fractures over time.
HIV can directly infect the cells that shed old bone tissue. HIV can also increase the activity of cells that break down bone tissue, sending signals to the body to make more cells that break down bone tissue, leading to bone loss.
Even with effective treatment, HIV viral proteins remain in the body and can send signals that cause fewer bone-forming cells to be produced or reduce the effectiveness of your bone production, resulting in a lower rate of new bone tissue formation.
HIV also affects the body’s immune system, which improves with treatments to fight the virus but does not disappear completely. Low levels of chronic HIV-related inflammation affect cells that remove bone tissue, which also leads to bone loss over time.
How do HIV medications contribute to bone changes and the risk of osteoporosis?
Treating HIV with antiretroviral therapy (ART) has provided tremendous medical benefits for people living with HIV, but it also puts strain on bones.
When a person first starts ART, in addition to reducing the concentration of HIV circulating in the body to undetectable levels, the immune system is also quickly strengthened to recover. This process causes more inflammation throughout the body. About a year after starting ART therapy, this inflammation leads to bone loss, with more bone tissue being removed than is produced.
Certain HIV medications cause more bone loss than others. Introducing a newer drug formulation with fewer bone 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), increase the risk of osteoporosis.
In addition, certain behaviors such as smoking and drinking alcohol are associated with osteoporosis and may be more common in people with HIV.
Advanced age is a risk factor for osteoporosis, especially for women. While it is known that people lose bone tissue as they age and have a higher risk of osteoporosis, this is particularly true for people with HIV, as not only are they at a higher risk of osteoporosis than people without HIV, but they can also develop osteoporosis at a younger age.
How can people with HIV prevent bone loss?
There are many methods people can use to maintain bone health and prevent bone loss, and all of these methods also apply to people with HIV. Getting the recommended calcium in your diet is important for maintaining strong bones. Because the body’s ability to absorb calcium decreases with age, older people require higher levels of calcium in their diet.
Vitamin D also plays an important role in bone health. This vitamin is useful for the body to absorb calcium from food, the skeleton to be renewed and mineralized, and the muscles to remain 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 ensure they get adequate amounts of both vitamins.
Quitting smoking and limiting alcohol consumption are also important measures to maintain general health and bone health.
Hormone therapy (HT) with estrogen has been shown to improve bone mineral density after menopause or in transgender women, although less is known about the effects of HT with testosterone on bone in transgender men.
Exercise plays a crucial role in bone health and preventing osteoporosis. Bones and muscles respond and strengthen when subjected to strenuous exercise (e.g. running or dancing). Regular exercise can help develop and maintain muscle and bone strength and improve balance, which will help prevent falls. Because osteoporosis is more common in people infected with HIV, they are more susceptible to serious injuries, such as a fracture, after a fall. If you take safety precautions at home, e.g. For example, eliminating tripping hazards, providing good lighting, making sure your glasses have the correct prescription and size, and wearing shoes with comfortable soles are all useful ways to prevent falls.
Tell your doctor if you feel dizzy or have fallen, and discuss the possibility that your medications play a role in your risk of falling, especially if you take many different types of medications. Also ask your doctor if your HIV medications are best for your bone health or if there are other options that have fewer side effects on your bones.
Read: 6 methods to strengthen your musculoskeletal system >>
Are there specific recommendations for bone health testing for people with HIV?
Because people with HIV have a higher risk of osteoporosis and bone fractures compared to people without HIV, there are specific recommendations for bone health testing as part of your routine health care.
The most common method for detecting osteoporosis is the dual-energy X-ray absorptiometry test (DEXA), which measures bone mineral density. The results are also useful for predicting a person’s risk of a serious fracture.
A DEXA test is recommended for all postmenopausal women with HIV and all HIV-infected people over 50 years of age.
People with HIV who are taking certain medications such as corticosteroids, have a history of fractures, or have medical conditions that put them at increased risk of osteoporosis and fractures should first undergo a DEXA test.
This educational resource was created with support from Merck.
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