Side Effects of HIV Medicines
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HIV and Osteoporosis
Last Reviewed: November 17, 2016
- 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 risk of osteoporosis increases with age. 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. Also, HIV medicines are helping people with HIV live longer, 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, 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 risk of osteoporosis increases with age. 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 faster in people living with HIV than in people without HIV. Factors that increase the rate of bone loss in people with HIV may include:
- HIV infection itself.
- Some HIV medicines.
- Taking other medicines for a long time (for example, steroids or antacids) can also increase the risk of osteoporosis.
- Older age. HIV medicines are helping people with HIV live longer, and advancing age increases the risk of 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 risk 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 with 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 and Hispanic 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 certain diseases that are more common in African Americans (such as lupus).
- Family history: Reduced bone mass tends to run in families.
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.
- Drinking: Too much alcohol can cause bone loss and broken bones.
How does osteoporosis develop?
To maintain healthy bones, our body constantly replaces old bone tissue with new bone tissue. Up to about age 20, bone tissue is replaced faster than it is lost. But beyond age 20, the reverse can happen: more bone can be 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 10 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. Women who are younger than 65 and are at high risk for fractures should also have a bone density test. 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. Other foods high in calcium include dark green leafy vegetables (such as collard greens, bok choy, spinach, and kale), broccoli, sardines, tofu, and almonds. Milk is fortified with vitamin D. Certain fish and mushrooms are also high in vitamin D. 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 too much can lead to bone loss and increase the risk of fractures due to both bone loss and falling. If you drink alcohol, drink in moderation—up to one drink a day for women and up to two drinks a day for men. One drink is a bottle of beer, a glass of wine, or a shot of liquor.
This fact sheet is based on information from the following sources:
- From the National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center:
- From the Department of Health and Human Services and the Department of Agriculture: Dietary Guidelines for Americans 2015-2020
- From the Department of Health and Human Services: Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents: Adverse Effects of Antiretroviral Agents
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