Bone Disease and HIV

September 2002

This article is part of The Body PRO's archive. Because it contains information that may no longer be accurate, this article should only be considered a historical document.

In the world of HIV there's no question that proper diet and regular exercise are both crucial. Both are equally critical; neither is more important than the other. Nothing more adequately illustrates this point than the emerging risks of bone disease associated with HIV.

Three major bone diseases account for the majority of the risk to the HIV-positive population. Osteoporosis is a disease in which bone mass and density are lost, making the bones fragile and easy to fracture. In osteopenia, bone mass and density are also lost, but to a lesser degree than osteoporosis. Osteopenia usually leads to osteoporosis. Conversely, avascular necrosis is characterized by bone death as a result of inadequate blood supply (damage to the blood vessels in that area of the bone). This article will deal with strategies for combating osteopenia and osteoporosis.

In the general population many factors can be used to predict the likelihood that one will develop osteopenia or osteoporosis. Female gender, older age, estrogen deficiency, Caucasian race, low body weight, family history, smoking and drinking alcohol or caffeine have all been linked to higher risks. HIV can add to these risk factors significantly through medications and other metabolic disorders associated with HIV.

There are several methods for detecting osteopenia and osteoporosis. Unfortunately, osteoporosis does not show up on a x-ray until one third or more of bone mass has already been lost. Doctors can also do a bone biopsy (in which they remove a small portion of bone), although this is quite invasive. The most reliable tool available at this time is the DEXA (dual-energy x-ray absorptiometry). This is a less invasive procedure that identifies bone mass and whether or not that mass is typical for gender and age. People who have several risk factors and suspect that they are losing bone mass should request that their doctor order a DEXA.


Nutritional and Exercise Strategies for Osteopenia/Osteoporosis

Although many risk factors for bone disease may be beyond control, diet plays a critical role in keeping bones strong. The hard, structural component of bone, hydroxyapatite, is composed of calcium salts and phosphate salts. Therefore, if the diet is deficient in calcium or phosphorus, bone mineral density may be adversely affected.

Calcium is found in relatively high amounts in dairy products such as milk, yogurt, and cheese, as well as in some vegetables like broccoli. Fortified juices like orange juice may be helpful supplements for those who do not tolerate dairy products well. Unfortunately, it is often difficult for some people to consume adequate quantities of dairy products, so calcium supplements are needed. Calcium cannot be absorbed into the body without vitamin D, so calcium supplements are the most beneficial when they include vitamin D. Do not exceed the dietary reference intake (DRI) for calcium (1000 mg) or vitamin D (400 IU) without the advice of your healthcare professional.

Phosphorus is also found in relatively high amounts in dairy products, although it is also found in beans (i.e. kidney beans or black beans), peanuts, and peanut butter. Most often, the amount of phosphorus found in most multivitamins is sufficient.

Also of the utmost importance is regular, consistent exercise. This can help preserve bone mass and increase bone mineral density. It is extremely beneficial whether the goal is to prevent bone loss, or to stop bone loss and try to increase bone mass. Exercise that involves weight or resistance is the most beneficial for bone health. Walking, working out with weights, stair climbing, hiking, aerobics, and jogging are all great workouts for those who are concerned about bone loss. The more often the exercise is performed, the better. Start slowly, and increase the amount of time you exercise by five minutes every two weeks. You should work up to three-seven times per week, about 20-60 minutes each time.

Other Considerations

Every exercise regimen should be discussed beforehand with your doctor. Likewise, you should consult a registered dietitian (RD) as well as your physician before initiating a new diet plan. Your doctor may recommend medications in addition to diet and exercise. These may include hormone replacement therapy (estrogen or testosterone) if those hormones are deficient in your body.


  1. Lewis M. HIV, Exercise, and Bone Health. Presentation at NIAC conference, New York. April, 2002.
  2. Mascolini M. Lipids, lactates, and lacy bones: sorting out causes and cofactors. IAPAC Monthly. 2001. 136-141.
  3. Horn T. Osteopenia, osteoporosis, and other bone problems in HIV-infected individuals. Physicians' Research Network. 2001.
  4. Fields-Gardner C. Connecting them dry bones. HIV Plus. 2001. 40.

This article was provided by AIDS Survival Project. It is a part of the publication Survival News.


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