Being HIV+ puts you at higher risk for bone disease. Doctors don’t know why this happens. It could be due to HIV itself, HIV drugs, or HIV+ people getting older.

There are three kinds of bone disease that may happen with HIV:

• Osteoporosis
• Osteopenia
• Avascular necrosis (osteonecrosis)

Osteoporosis and osteopenia are diseases that make your bones weak. This means that your bones can break easier. Avascular necrosis is a disease where blood vessels in the bone are damaged and that part of the bone dies.

Many different things can put you at risk for bone disease, and women are especially vulnerable. Other risk factors for bone disease include:

• Age (being older)
• Being white
• Having a low body weight (being skinny)
• Low levels of the hormone estrogen
• Smoking
• Drinking alcohol
• Too much caffeine
• Long-term use of corticosteroid drugs

The main way to find out if you have osteoporosis or osteopenia is to have a DEXA scan done to measure bone density. A DEXA is an easy and painless test, so people who are at high risk for bone disease should ask their doctor to order a DEXA scan.

Avascular necrosis causes pain in the joints, usually in the hip area. At first the pain might only occur when you put weight on the joint. In more severe cases the pain could be constant. An MRI scan can detect early stages. X-rays and other scans can detect advanced avascular necrosis.

Even though you cannot control some of the things that lead to bone disease, you can control one: your diet. The minerals calcium and phosphorus make up most of your bones. This means that if you do not get enough calcium or phosphorus in your diet, your bones may get weaker.

Calcium is found naturally in some foods, and it is fortified to (added to) others. Here is a list of some foods that contain calcium:

• Milk
• Yogurt
• Cheese
• Calcium-fortified orange juice
• Tofu
• Salmon with the bones

Most HIV+ people still need to take calcium pills every day even if they eat dairy products like milk, cheese, and yogurt. A registered dietitian can help you decide if you should take calcium pills. If so, it may be a good idea to take calcium pills with vitamin D in them, since your body cannot use calcium without vitamin D. You should be taking 1000 mg. of calcium and 400 IU of vitamin D. Talk to your doctor before taking any supplements and do not take more than these amounts unless your doctor tells you to.

If you don’t have joint pain, it is also important to exercise on a regular basis. When you exercise your muscles pull against your bones, which helps keep them healthy and strong. The best kind of exercise to keep your bones strong is exercise that uses weight such as:

• Walking (you can use ankle weights)
• Working out with weights or weight machines
• Stair climbing
• Hiking
• Aerobics
• Jogging

Start your exercise routine slowly. Every two weeks make your routine five minutes longer. In the end, you should be working out three to seven times a week, about 20-60 minutes each time.

Diet and exercise are most effective in preventing bone disease from occurring. They can also be helpful if you already have osteopenia or osteoporosis, but if these conditions already exist, your doctor may recommend a medication. Some of the medicines that are commonly used to treat osteoporosis include:

• Hormone Replacement Therapy (HRT)
  In women, replacing the hormone estrogen has shown to significantly decrease the number of fractures. However, HRT is controversial; some doctors believe that HRT could put women at higher risk for other diseases like breast cancer.
  
  In men, doctors may recommend replacing the hormone testosterone if blood levels are low. Studies have not been done to determine if replacing testosterone is an effective treatment for osteoporosis.
• Bisphosphonates
  Drugs like Fosamax and Actonel are widely used to treat and prevent osteoporosis in women. These drugs are taken once a week. It is important to make sure that you are also getting enough calcium and vitamin D when you are taking a bisphosphonate.
• Evista (raloxifene)
  A drug that is used to treat and prevent osteoporosis in postmenopausal women. This drug is supposed to work like HRT, but with fewer side effects. Doctors are still waiting for research to be done to see if it is actually safer than HRT.
• Miacalcin® (calcitonin)
  Calcitonin is a hormone in the body that is involved in calcium and bone metabolism. Unfortunately, calcitonin is only available in injection and nasal spray, and seems to produce more side effects than other osteoporosis drugs. It is also less effective in preventing fractures than the other drugs.

Follow these steps to help protect your bones:

• Ask your doctor for a DEXA scan if you are worried that you might have bone disease
• Follow a diet with plenty of calcium and vitamin D
• Seek the advice of a registered dietitian
• Take calcium supplements if needed (talk to your doctor first)
• Ask your doctor what exercises are safe for you, and start doing them
• Stop smoking and reduce your intake of caffeine and alcohol
• Tell your doctor if you are experiencing joint pain, especially in the hip area

1		Cheonis, N. (2002). Osteonecrosis and HIV Disease. Bulletin of Experimental Treatments for AIDS. 22-29: Retrieved July 2003 from http://www.thebody.com/sfaf/winter02/osteonecrosis.html.
2		Lewis, M. (2002). HIV, exercise and bone health. Presentation at NIAC Conference, New York.
3		Mascolini, M. (2001). Lipids, lactates, and lacey bones: Sorting out causes and cofactors. IAPAC Monthly. 136-141.
4		Tebas, P. (2001). Osteopenia, osteoporosis, and other bone problems in HIV-infected individuals. Physicians’ Research Network 6(3). 12-17: Retrieved July 2003 from http://www.prn.org/prn_nb_cntnt/pdf/tebas_v6n3.pdf. (note: free web registration required.)