Osteoporosis is named the silent illness for good cause. Individuals not often present signs of the bone situation earlier than a break or fracture occurs.
The phrase “osteoporosis” actually means porous bone as a result of it causes the pure holes in your bones to get greater, which makes your bones thinner and weaker and extra prone to break.
The danger for osteoporosis is particularly excessive amongst individuals residing with HIV. “There are a variety of ways in which having HIV contributes to modifications within the bone,” mentioned Anjali Sharma, M.D., M.S., a professor and researcher with a deal with HIV in ladies on the Albert Einstein School of Drugs.
We requested Sharma to interrupt down the other ways HIV can have an effect on bone well being and what individuals residing with HIV can do to stop osteoporosis.
Does the HIV virus itself contribute to modifications within the bone?
Sure, it does. Bone is continually being renewed, which retains the skeleton robust. When outdated bone is eliminated and new bone is changed on the similar website, it’s known as bone reworking. This repairs skeletal injury and prevents the buildup of outdated, brittle bone.
With osteoporosis, the steadiness between bone formation and bone loss is shifted so increasingly bone is misplaced however not changed. Consequently, the bone turns into weak and extra prone to break over time.
HIV can instantly infect the cells that take away outdated bone. HIV also can improve the exercise of bone-removing cells and sign the physique to make extra bone-removing cells, which ends up in bone loss.
Even with efficient therapy, HIV viral proteins stay within the physique and may sign the physique to make fewer bone-forming cells or disturb how properly they make new bone, tipping the steadiness towards much less new bone formation.
HIV additionally disturbs the physique’s immune system, which improves however doesn’t fully go away with therapy that controls the virus. Low ranges of HIV-related persistent irritation have an effect on cells that take away bone, which additionally results in bone loss over time.
How does HIV treatment contribute to bone modifications and threat for osteoporosis?
Therapy of HIV with antiretroviral therapy (ART) has led to great well being advantages for individuals with HIV but additionally has results on bones.
When an individual begins ART for the primary time, together with lowering the degrees of HIV circulating within the blood to undetectable ranges, the immune system rapidly builds again to revive itself. That course of results in elevated irritation all through the physique. For a couple of 12 months after starting any ART routine, this irritation results in bone loss, with extra bone being eliminated than fashioned on the similar time.
Sure HIV medications trigger extra bone loss than others. Switching to a more recent drug formulation with much less bone-related unwanted side effects has been proven to enhance bone density.
Are there another elements that contribute to bone loss in individuals with HIV?
Sure medical situations which are extra frequent in individuals with HIV, like persistent liver or kidney illness and early-onset menopause (earlier than age 45), put individuals at greater threat for osteoporosis.
Moreover, sure behaviors akin to smoking and alcohol use have been linked with osteoporosis and could also be extra frequent in individuals with HIV.
Older age is a threat issue for osteoporosis, notably for ladies. Whereas it’s recognized that individuals lose bone and have an elevated threat for osteoporosis as they age, that is very true for individuals with HIV who should not solely at greater threat for osteoporosis than individuals with out HIV but additionally might develop osteoporosis at a youthful age.
How can individuals with HIV stop bone loss?
There are a lot of methods individuals can preserve their bone well being and stop bone loss, and these all apply to individuals with HIV as properly. Having the really useful calcium in your weight-reduction plan is necessary to maintain bones robust. As a result of the physique’s capacity to soak up calcium goes down as they age, older individuals require greater quantities of dietary calcium.
Vitamin D additionally performs key roles in bone well being. It helps the physique take up calcium from meals, helps the skeleton renew itself and mineralize, and helps maintain muscle groups robust to cut back the chance of falling. Individuals with low vitamin D ranges might have to take a vitamin D complement and a calcium complement to ensure they’re getting sufficient of each.
Quitting smoking and limiting alcohol consumption are additionally necessary in an effort to preserve each general and bone well being.
Hormone therapy (HT) with estrogen after menopause or for transgender ladies has been proven to enhance bone mineral density, whereas much less is thought concerning the bone results of HT with testosterone for transgender males.
Train performs an important position in bone well being and osteoporosis prevention. Bones and muscle groups reply and strengthen when they’re burdened by weight-bearing workouts (akin to working or dancing). Common train will help to construct and preserve bone and muscle power and enhance steadiness to assist stop falls. As a result of osteoporosis is extra frequent in individuals with HIV, they could be extra prone to have a critical damage after a fall, akin to a fracture. Taking security precautions within the house, akin to eradicating journey hazards, making certain good lighting, ensuring your eyeglasses are the precise prescription and match, and sporting snug flat footwear, are all methods to assist stop falls.
Let your healthcare supplier know for those who really feel dizzy or have had a fall and focus on whether or not any of your drugs is likely to be enjoying a job in your threat of falling, particularly for those who’re taking many various kinds of drugs. Additionally ask your HCP in case your HIV drugs are essentially the most bone-friendly or whether or not there are different choices for you which have much less unwanted side effects on bone.
Are there particular bone well being screening suggestions for individuals with HIV?
As a result of individuals residing with HIV are at greater threat for osteoporosis and fractures in comparison with individuals who aren’t residing with HIV, there are particular bone well being screening suggestions for his or her routine healthcare.
The most typical strategy to display screen for osteoporosis is by utilizing a twin power X-ray absorptiometry (DEXA) scan, which measures bone mineral density ranges. The outcomes will also be used to assist predict an individual’s threat of getting a critical fracture.
A DEXA scan is really useful for all ladies with HIV after they undergo menopause, and for everybody with HIV beginning at age 50.
Individuals with HIV who take sure drugs like steroids, have a historical past of fracture or have situations that put them at excessive threat for osteoporosis and fracture ought to have a DEXA scan at an earlier age.
This academic useful resource was created with help from Merck.
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