Bone health and HIV disease

February 2008     View PDF     En español

Preventing bone loss

Almost 80% of your bone density is determined by your heredity. The other 20% can be affected by changes in lifestyle. In general, many of the ways to prevent bone loss in people with HIV are the same for postmenopausal women. Some strategies have been tested in HIV-positive people.

Lifestyle
Changing your lifestyle can help prevent bone loss. Keeping a normal body mass is one important way— keeping your weight in proportion to your height and body frame. Smoking and drinking alcohol also contributes to bone loss, as well as excessive caffeine use. So reducing tobacco, caffeine and alcohol use is likely to benefit your bone health.

Bone loss can also occur from injuries to the bone, like a fracture or break. By reducing your risk of falling or tripping, you can help prevent bone injuries. Adults may need to safeguard their lives as they get older. Being aware of your surroundings, clearing clutter from your home, and carefully walking up and down stairs or hills are just a few ways to lower your risk.

Diet
In general, Americans do not get enough calcium or vitamin D to maintain their bone health. This also applies to people with HIV of all ages. Most adults should get between 1,000–1,200mg of calcium a day. Pregnant and postmenopausal women should get 1,500mg. Daily amounts should not exceed 2,000mg. You can get calcium from eating milk products, tofu, and vegetables and leafy greens like broccoli and spinach. Some foods are enriched with added calcium, like orange juice.

Some people, including older adults, may not get enough vitamin D due to a lack of physical activity or exposure to sunlight. The daily amount for most adults is 200 IU. For men and women 50 and above, the amount should increase to 400–600 IU a day. People with osteoporosis may need up to 800 IU daily.

Vitamin D is found in eggs, liver, some fish oils, and fish like salmon and swordfish. You can also get enough vitamin D by getting about a half hour of sunlight each day, as your body makes it from the contact of sun to your skin. This may be more difficult for people with low physical activity or during winter months.

Phosphorus is another mineral important to maintain bone health. It’s found in milk products, peanuts and beans, though most people do not need to take extra amounts of it.

Exercise
Being active day to day and getting exercise helps make bones denser and stronger. Weight-bearing activities force your body to work against gravity. These include power walking, jogging, climbing stairs, dancing or running, where your legs and feet support your body’s weight. Resistance exercises include stretching and lifting weights to help strengthen your muscles and bones. Before beginning an exercise routine, talk to your doctor or a certified trainer to learn the type of exercise that would be best for your health.

Supplements
Supplements can help support your body’s ability to stop and reverse bone loss. Many people do not get enough calcium or vitamin D in their diets. Some cannot tolerate milk products or consume foods high in calcium. Still others, including older adults who go without direct sunlight for periods of time, may not get enough vitamin D. Taking supplements may be an option in these cases.

Many drugstores and health food stores sell calcium tablets, and some come packaged with vitamin D. Discuss with your health provider all supplements you take or want to take to ensure you’re getting the right daily amount. High levels of calcium and vitamin D can cause problems of their own. If you take a multivitamin, check the label as many already contain calcium and vitamin D.

Prescriptions
Certain prescription drugs can increase bone loss, especially when used over time or at high doses. Avoiding or switching from these medicines can help. Some of these are HIV-related drugs like pentamidine, steroids like cortisone and prednisone, or other drugs like phenobarbital and ketoconazole. Talk to your health provider or pharmacist about which increase bone loss and discuss your options.

How is bone loss diagnosed?

LAST      NEXT

Treating bone loss