HIV increases the risk of osteoporosis
Three studies published in the last year found a high incidence of osteoporosis in men living with HIV. Dr Mary Romeyn, a San Francisco HIV doctor, found that a 13 of 17 men with CD4 cell counts less than 100 had osteopenia (thin bones) or osteoporosis. Tebas et al found that men on protease inhibitors had a higher incidence of osteopenia and osteoporosis than men whose medications did not include protease inhibitors. HOY et al found that about 38% of men with lipodystrophy also had osteopenia or osteoporosis.

What this means for women living with HIV
Since all of these studies were done on men, we don’t have a clear picture of how many HIV + women are at risk of developing osteoporosis. Women in general have a greater chance of getting osteoporosis than men, especially menopausal, underweight, Asian, Caucasian, and amenorrheal women (no periods). However, the type of osteoporosis that develops due medications or disease is different and may not occur more often in women. We do not know the answer to this yet. Meanwhile it is a good idea to do what you can to take care of your bone health.

Nutrition and lifestyle
Calcium: Men and premenopausal women need 1000 mg per day from food and/or supplements. Post-menopausal women and adults who have had a long period of bed rest due to illness need 1500 mg. It is hard to get this amount of calcium from diet alone. There are numerous calcium supplements on the market, including TUMS, which contain calcium carbonate and work very well. Calcium supplements made from bone meal or dolomite sometimes contain lead or other heavy metals and so may not be safe. Calcium citrate is more expensive but easier to digest. Do not take more than 1500 mg per day without medical advice.

Vitamin D: Vitamin D (400-800 IU) is required to use the calcium. Most multivitamins contain 400 IU, which is enough for most people. Do not take more than 1000 IU per day.

Magnesium: Whether extra magnesium is required with calcium supplements is controversial. If you tend to get constipated magnesium will be helpful. If you have diarrhea magnesium might make it worse. In fact, calcium supplements alone might make diarrhea better.

Food sources of calcium: The highest sources of calcium are milk products, fortified soymilk and fortified orange juice. Other good sources include canned fish (with bones), firm tofu, sesame seeds, almonds, greens, Chinese broccoli, oolichans. Many other plant foods contain low to moderate amounts of calcium.

Salt and caffeine: Foods high in salt cause calcium to be lost from the body. Caffeine causes bone loss, even with as little as 2 cups per day.

Cigarettes and alcohol: Smokers have lower bone mass (thinner bones) and heavy drinking increases the risk of osteoporosis.

Exercise: Weight bearing exercise like walking, running or weight lifting can increase bone density. Swimming and cycling do not. If you have been sick or are not used to exercise ask your doctor for a referral to a physiotherapist to get started.