Bone health and HIV disease
February 2008 View PDF En
español
Treating bone loss
Currently, there are no standards of care for using
bone density tests or treating bone loss in people with HIV. What
we know about treating bone loss comes from research on postmenopausal
women and older men and men with low levels of testosterone.
Pain
relievers
Your doctor may prescribe pain killers like aspirin and ibuprofen.
These help control any discomfort you may be having but will not
correct actual bone loss.
Medicines used for resorption problems
A few medicines called bisphosphonates lower the rate
of bone resorption, thereby stabilizing bone density. Little is
known about how they affect people with HIV. They may be prescribed
with calcium and vitamin D supplements. Side effects can include
difficulty swallowing, inflammation of the esophagus, and gastric
ulcer.
Bisphosphonates
This type of drug is often prescribed for bone less. However, early
results from a large study reported in January 2008 show some evidence
of aseptic osteonecrosis—a bone condition that results
from poor blood supply causing bone death. Though the rate for
this side effect is relatively low, it may be an issue for some
people, notably older adults. Bisphosphonates have a long half-life
of up to 10 years, which may allow them to reside in bone tissue
and cause bone damage
Drug |
Dose |
Approved
to |
Note
for people
with HIV |
Actonel
(risedronate) |
5mg
once a day or 35mg once a week, taken on empty stomach
and remain upright for 30 minutes. |
Prevent
and treat postmenopausal osteoporosis and osteoporosis
in women and men due to using corticosteroids. Lowers the
rate of spine, hip and other fractures. |
No
studies have been done in people living with HIV. |
Boniva
(ibandronate) |
150mg
once a month on the same day of the month, taken on empty
stomach and remain upright for 30 minutes. An injection
is also available, given once every 3 months. |
Prevent
and treat postmenopausal osteoporosis. Lowers the rate
of spine fractures. |
No
studies have been done in people living with HIV. |
Fosamax
(alendronate) |
Prevention:
5mg once a day or 35mg once a week; treatment: 10mg once
a day or 70mg once a week, taken on empty stomach and remain
upright for 30 minutes. |
Prevent
and treat postmenopausal osteoporosis; treat osteoporosis
in men; treat osteoporosis in women and men due to using
corticosteroids. Lowers the rate of spine, hip and other
fractures. |
Only
one study has been done in people with HIV. The results
showed, over a one-year period, that the BMD of the spine
had significantly improved while other body parts stayed
about the same. |
Medicines used for hormone therapy
Short-term hormone therapy is used to relieve hot flashes
and other symptoms of menopause. However, in postmenopausal women,
it also prevents bone loss and fractures and improves bone density.
Many brands come as a pill or skin patch.
Estrogen therapy is usually
given with progesterone, which lowers the risk of cancer of the
uterus. Its long-term use can increase the chances for heart attack,
blood clots, stroke and breast cancer. Therefore, weigh the pros
and cons of hormone therapy with your health provider when considering
it for bone loss.
Another type
of estrogen is called a SERM (selective estrogen
receptor modulator). Evista (raloxifene) prevents and treats
postmenopausal osteoporosis, improving the density of the spine
and neck. Unlike other estrogen therapy, Evista is less likely
to cause cancer of the uterus. Side effects can include hot flashes,
leg cramps, blood clots, vaginal dryness, swelling, pain or tenderness,
muscle and joint aches, and weight gain.
As for men, taking testosterone
will help prevent or treat bone loss, especially in the spine.
It’s not used in women. One
small study in men with HIV showed that the density of the spine
had significantly improved. Several brands come as an injection
(taken every 2–3 weeks), gel (rubbed on skin daily) or skin
patch. Many men who take this therapy report feeling better and
having more energy. It should not be taken by men with prostate
cancer. Side effects can include swelling in the hands and feet
and enlarged prostate gland and breasts.
Medicines used to form
bone tissue
Parathyroid hormone helps your body store a healthy amount
of calcium and phosphorus in your bones. A rather new form of this,
Forteo (teriparatide), improves bone density in men and women.
It’s
given by injection once a day, is currently approved for only 24
months of use, and costs more than other bone loss therapy.
Forteo
lowers the risk of fractures in postmenopausal women and likely
also in men. It’s used for treating postmenopausal
osteoporosis, and for primary osteoporosis and secondary osteoporosis
caused by low testosterone in men. No studies have been done in
people with HIV. The most common side effects include headache,
nausea, vomiting, leg cramps and dizziness.
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