Bone health and HIV disease

February 2008     View PDF     En español

Research on bone loss

Much of what we know about bone loss has come from the research done in postmenopausal women and older men. Although this helps, it doesn’t answer the unique issues that people living with HIV face, especially as they begin to confront bone loss earlier. Unfortunately, the results so far have tended to contradict one another.

One belief is that HIV itself affects bone loss. In general, people with HIV face more bone loss than HIV-negative people of the same sex and age. Why this happens is not clear. HIV activates the immune system, which in turn may affect bone health. Since it infects different cells in the body, it may also affect bone marrow cells which may then affect bone health. HIV can also increase the level of proteins which may add to the loss of bone tissue.

Another belief is that HIV drugs help cause bone loss, specifically protease inhibitors. A couple of studies have reported this, but others have not. Protease inhibitors also tend to deplete the body of vitamin D, which is key to keeping bones strong. Recent research showed that Viread (tenofovir) contributed to some bone loss, but it’s not confirmed by other studies. Some data point to NRTIs in general. Yet another study compared two different HIV class regimens and found that neither affected bone loss.

These studies stress the need for more research on finding the underlying reasons for bone mineral loss and other bone disorders in people with HIV. This will help people living with HIV and their doctors get ahead of this issue before serious bone damage can occur.