Risks to Your Bones (Osteopenia & Osteoporosis) en español
What about prevention & treatment?
At the present time, there is no way to cure osteoporosis. However, there are ways to help prevent it and treat it.
General Considerations for Everyone
Unfortunately, not a lot is known about these various approaches for the management of osteoporosis (or osteopenia) in HIV-infected people. Much of what we do know about these management techniques comes from studies involving postmenopausal women (women who are no longer menstruating) or men with other secondary causes of osteoporosis, such as high-dose or long-term corticosteroid use. But there are some instances in which these strategies have been tested in HIV-positive people with osteopenia/osteoporosis.
It is generally agreed that all HIV-positive people can reduce their risk of developing osteoporosis through the following strategies:
Calcium and vitamin D intake: While calcium alone cannot prevent or cure osteoporosis, it plays an important role in maintaining bone health. According to the National Academy of Sciences, adults between 19 and 50 years of age should be receiving approximately 1,000 mg of calcium a day; adults 51 years of age and older should be receiving approximately 1,200 mg of calcium a day. Yet surveys have shown that many Americans are not consuming enough calcium to maintain bone health; studies have also shown that HIV-positive people of all ages are lacking in calcium intake.
Foods rich in calcium include milk, cheese, tofu, and broccoli. Other foods, including orange juice, are often calcium enriched, meaning that calcium has been added by the manufacturer. For people who are unable to consume enough calcium-rich foods, calcium supplements can be purchased through grocery stores, pharmacies, and health food shops. Be sure to discuss any supplements you buy – or plan to buy – with your doctor.
Vitamin D is also important, as it helps the small intestine to absorb calcium. It also slows the removal of calcium from the body by the kidneys. In other words, calcium and vitamin D work together to help maintain bone health. Vitamin D is manufactured in the skin following direct exposure to sunlight. Most people are able to get enough sun exposure in their day-to-day lives and do not need vitamin D supplementation. However, for certain individuals – including older adults and people who go without direct sun exposure for extended periods of time – vitamin D supplementation is important. The major food sources of vitamin D are vitamin D-fortified dairy products, egg yolks, saltwater fish, and liver. Oral vitamin D tablets are also available, but it is important to be careful with these, as high doses of vitamin D can be harmful. Many calcium supplements also include vitamin D, and will say "calcium plus" of "calcium +D" on the label.
Exercise: Like muscle, bone is living tissue that becomes bigger, denser, and strong with consistent exercise. To maintain and increase bone density and strength, both weight-bearing exercises and resistance exercises are helpful. Weight-bearing exercises include activities that force your muscles and bones to work against gravity – such as running, jogging, walking, and stair climbing – in which the feet and legs bear the weight of the body. Resistance exercises – including weight lifting and various stretching routines – draw upon muscle strength to strengthen muscles and bones. For best results, it's probably best to work with a physical therapist or a certified trainer to determine the best exercises for maintaining bone health.
Lifestyle changes: maintaining a normal body mass index (body weight proportional to height and frame size) and avoiding tobacco and alcohol use are key factors to consider.
Be careful with certain prescription drugs: Certain medications, especially if they are used at high doses or for long periods of time, can increase bone loss. For people with osteopenia or osteoporosis, stopping (or switching) certain drugs – including corticosteroids (e.g., prednisone and cortisone), phenobarbital, pentamidine, and ketoconazole – should be discussed with a healthcare provider.
As for anti-HIV medications, it's still not clear which, if any, anti-HIV medications can be blamed for the increased rates of osteopenia and osteoporosis in HIV-infected people. In turn, there are no recommendations regarding which anti-HIV medications should be avoided or switched in HIV-positive with – or at risk for – decreased bone density. In fact, studies evaluating the effects of switching from a PI-based regimen to an NNRTI-based regimen have not consistently found any positive effects on BMD in HIV-infected people.
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