Bone Health

Bone is a living organ. Throughout your life, the body removes old bone and replaces it. As you get older, the body is less able to do this, leaving bones thinner and weaker. Other factors can also weaken bones, such as smoking, low vitamin D levels, medication side effects, and having HIV. Osteoporosis means that the bones become porous, brittle, and subject to fracture. Osteopenia is a lack of bone minerals that can lead to osteoporosis.


HIV causes the body to remove old bone more quickly than normal and slows down the creation of new bone. In addition, certain HIV meds can weaken bones.


When bones are weak, even a light fall can break them, leading to a major loss of function. For example, people with hip fractures have hip pain and cannot walk until they have surgery. Even after surgery, some people cannot walk as well as they used to. Broken bones can also lead to other health problems, and even death.

What you can do with your doctor


People with HIV age 50 and older should get checked for weak bones, since they may not have any symptoms until a lot of damage has been done. A bone density scan, sometimes called a DEXA scan, is a painless way to check your overall bone health. Even if you have little bone damage, getting a bone scan or other tests may be a good idea since these tests can give you a baseline of your bone health to reference as you age.


There are medications that can slow down bone loss and help the body build bone faster. Your doctor may also prescribe calcium and vitamin D, which the body can use to build new bone.


If your doctor recommends medications for bone health, take them as prescribed.

Bone treatments will not work if not taken correctly. Also, the lower your HIV viral load, the stronger your bones will be.

What you can do yourself


Our body uses calcium and vitamin D to build bones. A good diet can usually provide all your bones need to stay healthy. If you’re not sure your diet has enough calcium and vitamin D, ask a nutritionist.


Exercise strengthens bone and lowers the chance of accidents and falls. Even a little bit of exercise helps, so any exercise is better than none. Simply walking and using stairs instead of elevators can help. Load-bearing exercise, (lifting weights or using weight machines) often called resistance training, has been shown to be particularly effective at improving bone strength, even in people over 70. If you are not sure where to start, see a physical therapist – don’t just join a gym without getting some training first.


Smoking and too much alcohol weaken bone and cause many health problems. Too much alcohol is unhealthy. People with HIV should have no more than one drink a day. “One drink” means a bottle of beer, a glass of wine, or a shot of liquor, like gin or vodka.

It’s important to be honest with your doctor about how much you drink. Ask if that amount is right for you and be sure to drink safely (never while driving or using machinery). Also, ask if alcohol will interact with any of your meds.


Bone health in many older adults with HIV is known to be poorer compared to other people of the same age without HIV. The frequency of problems can also be as much as three times higher. The technical terms are low Bone Mineral Density (BMD), osteopenia, and osteoporosis. Lower BMD means that there are extra spaces inside the bone that result in less strength of the bone. If BMD is somewhat lower it is called osteopenia and if even lower it is labeled osteoporosis. A separate designation is made for osteonecrosis of the hip, where the blood supply has been damaged and may lead to a fracture, even without a fall.


Certain factors can play a role in bone loss, such as low testosterone, low calcium, smoking, and general health factors like stress, lean body mass, and sedentary lifestyle.

There have been reports of certain HIV medications being associated with lower BMD, especially at the beginning of therapy. In particular, tenofovir has been implicated in lowering the BMD, but it appears that this negative process is short lived and within a year has not progressed.


A panel of experts has recommended screening for reduced BMD in older adults with HIV who are post-menopausal women or men 50 years or older. The preferred method is “DXA” or dual-X-ray absorptiometry. This approach is pain free and does not use excessive radiation. Usually, measurements are made in the area of the hip (femoral neck) and the spine. The machine generates a “T-score” that is compared to the average score of a healthy young adult taking the same test. The comparison is made in units called standard deviations. If the bone density test of the patient is between 1 unit and 2.5 units lower than the normal, then a diagnosis of osteopenia is made. A score of 2.5 or more below normal means osteoporosis. Even without the test, a fracture in these areas without trauma (fragility fracture) is consistent with osteoporosis.


Because of the known association between HIV in older adults and bone softening, you and your doctor may decide to increase the intake of calcium and vitamin D. This could be in foods or dietary supplements. Also, exercise, including muscle strengthening, smoking cessation, and drinking less alcohol, can also help improve bone health. Taking step to prevent falls, such as balance training and strength building, can also have positive effects on bone health.

The best treatment approaches for you should be discussed with your healthcare provider. Your provider might review your current medications and make changes that could reduce negative effects on your bone health. In more extreme cases, your provider might prescribe specific medications for osteopenia or osteoporosis. Further discussion of these issues is available by here.