Proven Information About HIV and Osteoporosis

Does the HIV virus itself affect bone changes?

Yes, that’s right. Bones continually regenerate to maintain a strong skeleton. Removing old bone tissue and replacing it with new bone tissue in the same location is called bone remodeling. This helps heal skeletal injuries and prevents the build-up of old, fragile bone tissue.

With osteoporosis, the balance between bone formation and loss is altered, causing more and more bone tissue to be lost rather than replaced. As a result, bones become weaker and more likely to fracture over time.

HIV can directly infect cells that shed old bone tissue. HIV can also cause bone loss by increasing the activity of cells that break down bone tissue and signaling the body to produce more cells that break down bone tissue.

Even with effective treatment, HIV viral proteins may remain in the body, slowing the rate at which new bone tissue is formed by signaling to reduce the number of bone-forming cells or altering the efficiency of bone formation.

HIV also affects the body’s immune system, which improves with treatments that control the virus but does not make it go away completely. Low-level chronic HIV-related inflammation affects the cells that remove bone tissue, which also causes bone loss over time.

How do HIV medications affect bone changes and risk of osteoporosis?

Treating HIV with antiretroviral therapy (ART) has tremendous medical benefits for people living with HIV, but it also takes a toll on bones.

When a person first begins ART, the level of HIV circulating in the body is reduced to undetectable levels, while the immune system is rapidly strengthened and recovered. The process causes more inflammation throughout the body. For about a year after starting ART therapy, this inflammation causes bone loss, removing more bone tissue than is being created.

Certain HIV medications cause more bone loss than others. Adopting new drug formulations with fewer bone side effects has been shown to improve bone mineral density.

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

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.

Additionally, certain behaviors, such as smoking or drinking alcohol, have been linked to osteoporosis and may be more common in people with HIV.

Old age is a risk factor for osteoporosis, especially in women. It is known that older people lose bone tissue and are at higher risk for osteoporosis, but this is especially true for people with HIV because not only do they have a higher risk of osteoporosis than people without HIV, but they may also develop osteoporosis at a younger age.

How can people with HIV prevent bone loss?

There are many ways to maintain bone health and prevent bone loss, all of which also apply to people living with HIV. To maintain strong bones, it is important to get the recommended amount of calcium in your diet. Because the body’s ability to absorb calcium decreases with age, older people need higher nutritional levels of calcium.

Vitamin D also plays an important role in bone health. This vitamin is helpful in helping your body absorb calcium from food, helping your skeleton regenerate and mineralize, and keeping your muscles strong, reducing your risk of falls. People with low vitamin D levels may need to take vitamin D supplements and calcium supplements to ensure adequate levels of both vitamins.

Quitting smoking and limiting alcohol consumption are also important steps to maintain overall health and bone health.

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

Exercise plays an important role in bone health and preventing osteoporosis. Bones and muscles respond and strengthen when put under pressure from load-bearing exercises (e.g. running or dancing). Exercising regularly helps prevent falls by building and maintaining muscle and bone strength and improving balance. Because osteoporosis is more common in people with HIV, they are more likely to suffer serious injuries, such as fractures after a fall. Taking safety precautions at home, such as eliminating fall hazards, ensuring good lighting, making sure your glasses are the correct prescription and size, and wearing shoes with comfortable soles, are all helpful ways to prevent falls.

Tell your healthcare provider if you feel dizzy or have fallen, and talk about the possibility that your medications may affect your risk of falling, especially if you take different types of medications. Also, ask your health care provider whether HIV medications are best for your bone health or if there are other options with fewer side effects on your bones.

Read: 6 ways to strengthen your musculoskeletal system >>

Are there specific bone health testing recommendations for people living with HIV?

Because people with HIV infection have a higher risk of osteoporosis and fractures compared to people without HIV infection, there are specific bone health screening recommendations for routine health care.

The most common way to detect osteoporosis is with a dual-energy x-ray absorptiometry (DEXA) test, which measures bone density levels. The results can also be useful in predicting the risk of serious fractures.

DEXA testing is recommended for all women infected with HIV after menopause and all people with HIV over the age of 50.

People with HIV who take certain medications such as corticosteroids, people with a history of fractures, osteoporosis and conditions that put them at higher risk for fractures should get a DEXA test first.