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Side Effects of HIV Medicines

HIV and Osteoporosis

(Last updated 5/7/2014; last reviewed 5/7/2014)

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Key Points

  • Osteoporosis is a disease that causes bones to become weak and easy to break. Osteoporosis increases the risk of fractures of the hip, spine, and wrist. 
  • The main risk factor for osteoporosis is advancing age beyond 30. Anyone can get osteoporosis, but it’s most common in older women.
  • Factors that may increase the risk of osteoporosis in people living with HIV include HIV infection itself and some HIV medicines (for example tenofovir, [brand name: Viread]). Also, people with HIV are living longer because of HIV medicines, and advancing age increases the risk of osteoporosis.
  • Other risk factors for osteoporosis include a poor diet, physical inactivity, and smoking. These risk factors can be managed by lifestyle changes. For example, eating a healthy diet that includes foods rich in calcium and vitamin D and doing weight-bearing exercises can make bones stronger and help slow the rate of bone loss. 

What is osteoporosis?

The human body is made up of more than 200 bones, ranging from the skull to the bones of the toes. We depend on bones to hold us up, help us move, and protect our internal organs, such as the heart, kidneys, and liver. Osteoporosis is a disease that causes bones to become weak and easy to break. Osteoporosis increases the risk of fractures of the hip, spine, and wrist. 

The main risk factor for osteoporosis is advancing age beyond 30. Anyone can get osteoporosis, but it’s most common in older women.

Are people with HIV at risk of osteoporosis?

Yes. Experts are not sure why, but bone loss occurs at a higher rate in people living with HIV. Factors that increase the rate of bone loss in people with HIV may include:

  • HIV infection itself
  • Some HIV medicines. For example, in several studies, bone loss has been linked to the use of tenofovir (brand name: Viread). AtriplaCompleraStribild, and Truvada are combination medicines that include tenofovir. (Combination medicines contain two or more different HIV medicines in one pill.) Bone loss was also seen in people with HIV who participated in studies of other HIV medicines.
  • Taking other medicines for a long time (for example, steroids or antacids) can also increase the risk of osteoporosis. 
  • Older age. Because of HIV medicines, people with HIV are living longer, and advancing age increases the risk of osteoporosis.

Staying healthy with HIV includes taking steps to prevent osteoporosis.

What are other risk factors for osteoporosis?

There are many risk factors for osteoporosis. Some risk factors, such as HIV infection, can’t be changed. Other risks factors, for example a poor diet or lack of exercise, can be managed with lifestyle choices.

Risk factors for osteoporosis that can’t be changed include:

  • Age: The risk of osteoporosis increases as people get older and the bones become thinner and weaker.
  • Gender: Compared to men, women have smaller bones, and after menopause, women lose bone more rapidly than men do. 
  • Race/ethnicity: The risk of osteoporosis is greatest for white and Asian women. However, even though African-American women tend to have higher bone density than white women, they are still at risk for osteoporosis. Factors that increase the risk of osteoporosis in African-American women include a low-calcium diet, intolerance to lactose (the main sugar in milk), and presence of diseases such as sickle cell anemia and lupus that are more common in African Americans. African-American women are also more likely to die from osteoporosis-related fractures than white women.     
  • Family history: Osteoporosis tends to run in families. 
  • History of a previous fracture: People who have had a fracture after the age of 50 are at high risk of having another.
The following risk factors for osteoporosis can be controlled by lifestyle choices:
  • Poor diet: A diet low in calcium and vitamin D increases the risk of osteoporosis.
  • Physical inactivity: Bones become stronger with exercise, so physical inactivity increases the risk of osteoporosis.
  • Smoking: Smoking is bad for the bones. 

How does osteoporosis develop?

To maintain healthy bones, our body constantly replaces old bone tissue with new bone tissue. Up to about age 30, bone tissue is replaced at a faster rate than it is lost. But beyond age 30, the reverse is true: more bone is broken down than is replaced. 

Osteoporosis develops when bone loss is so great that bones can break easily. There is no cure for osteoporosis. However, once the disease develops, there are medicines that can slow down bone loss or increase bone formation. 

What are the symptoms of osteoporosis?

Osteoporosis is often called a silent disease because bone loss occurs without symptoms. The first sign of osteoporosis is often a broken bone. 

A bone density test is used to measure bone strength and diagnose osteoporosis. The test takes about 15 minutes and is safe, painless, and requires no preparation. The U.S. Preventive Services Task Force recommends all women above the age of 65 have a bone density test to screen for osteoporosis. There are currently no recommendations for routine screening for osteoporosis in people living with HIV, but individuals infected with HIV may wish to discuss bone density testing with their health care providers.

What are steps to take to prevent osteoporosis?

Preventing osteoporosis means making lifestyle choices to reduce the risk of the disease.

  • Eat a healthy diet rich in calcium and vitamin D. Foods high in calcium include dairy products, such as milk, yogurt, and cheese. Milk is also fortified with vitamin D. Other foods high in calcium include broccoli, sardines, tofu, and oranges. If needed, heath care providers can offer guidance on taking calcium and vitamin D supplements. 
  • Stay active. Weight-bearing exercises, such as walking, jogging, and dancing, can make bones stronger and help slow the rate of bone loss. 
  • Don't smoke. 
  • Cut down on alcohol. Drinking a lot can lead to bone loss and increase the risk of fractures due to both bone loss and falling. People who drink should consume alcohol in moderation. Moderate drinking means limiting alcohol intake to 1 drink per day for women and up to 2 drinks per day for men.
  • Avoid falls. Keeping rooms well lit and free of clutter is one way to prevent falls at home.

How can I learn more about osteoporosis?


This fact sheet is based on information from the following sources:

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