Loss of bone mineral density (osteopenia), which can lead to more fragile and brittle bones (osteoporosis) is a common condition associated with ageing. Osteoporosis is most common in post-menopausal women.
People with HIV may be at increased risk for osteopenia and osteoporosis because:
- the lifestyle risk factors are more prevalent amongst people with HIV
- some antiretroviralA medication or other substance which is active against retroviruses such as HIV. medications are associated with increased risk
- HIV itself may cause metabolic changes that decrease bone mineral density(BMD).
Vitamin D is essential for bone health, because it helps:
increase the absorption of calcium and phosphorous from the stomach
regulate the amount of calcium in the blood
strengthen the skeleton.
For Australians, the main source of vitamin D is from exposure to sunlight. Vitamin D3 is formed by the action of sunlight (UV light) on the skin. A deficiency of vitamin D can contribute to osteoporosis because without it, calcium will not be fully absorbed by your body.
Lifestyle risk factors for osteopenia include:
- excessive alcohol
- a very low body weight
- low levels of physical activity
- lack of calcium and vitamin D in the diet
- low levels of oestrogen or testosterone.
What you can do?
Prevention is better than cure
Ways that you can decrease the risk of bone mineral density loss includes:
- making sure you have adequate levels of calcium in your diet: Low fat dairy products and leafy green vegetables are good sources of calcium. Calcium and vitamin D supplements are also available
- regular weight-bearing exercise: Walking, jogging, regular dancing and a host of other physical activities help to strengthen bones
- stop smoking, and avoiding excessive alcohol; both accelerate bone loss
- to get enough sunlight to produce vitamin D, a person needs to expose their hands, face and arms (around 15% of body surface) to sunlight for about 6–8 minutes, 4–6 times per week (before 10am or after 2pm in summer, for moderately fair people).
Get appropriate screening of your bone mineral density (BMD)
If your doctor considers you to be at increased risk of osteopenia or osteoporosis, he/she will recommend you have an x-ray (called a DEXA scan) to assess your BMD.
This will usually be recommended if:
- you have the lifestyle risk factors described above
- your medications include drugs that may increase the risk of bone mineral density loss (some protease inhibitorsA type of anti-HIV drug that works by preventing the production of an enzyme, protease, that HIV needs to replicate. are considered to increase the risk)
- you are a post-menopausal woman with HIV
- you are over 65.
If you have these lifestyle risk factors and are concerned about their long term implications, you may want to initiate a discussion with your doctor about having a screening test of your bone mineral density.
Take more active steps, including appropriate treatment, if you are diagnosed with low BMD
If you have low BMD then you are considered to be at increased risk of bone fractures (osteoporosis). In this case, treatments that may be recommended for you include:
- dietary supplements of calcium and vitamin D
- prescription drugs used to prevent and treat osteoporosis.
If you have osteoporosis and active symptoms (e.g. pain) then devices such as canes or even a walker can reduce the risk of falls and diminish pain. If pain is a problem, then exercise classes like aqua-aerobics may be available as an alternative to walking.
Ahead of Time: A practical guide to growing older with HIV