HIV and bones should both be priority topics at any time. But possibly in the modern context, people are more concerned with HIV. However, the effect on your bones of this insidious disease should not be neglected.

While HIV is primarily associated with effects on the immune system – leading to acquired immunodeficiency syndrome (AIDS) – it’s important to understand that it can also have significant impacton your bone health. HIV creates a complex relationship with your bones, involving a multitude of factors that may contribute to bone loss, fracture risk, and other potentially uncomfortable complications.

This is a heads-up warning to take care – not only insuring that you don’t contract HIV, but that,should you already have the condition, you are aware of the danger to your bones. While the information is scientific in nature, you need to take time to study and examine the difficulties HIV may bring to the bones.

Direct effects on bone cells: HIV infection can directly affect bone cells and the process of bone remodelling. Put more succinctly, HIV can lead to an increase in osteoclast activity, which are the cells responsible for bone resorption. This heightened activity can result in a loss of bone density, increasing the risk of fractures over time. On the other hand, the function of osteoblasts, which are thecells that facilitate bone formation, may also be impaired, leading to an imbalance in bone remodelling.

Inflammation and immune activation: HIV triggers chronic immune activation and inflammation, even in individuals on anti-retroviral therapy (ART). These sustained inflammatory responses can contribute to bone loss by influencing the bone cell function. Chronic inflammation can disrupt the delicate balance between bone formation and resorption, contributing to a reduction in bone density.

Anti-retroviral therapy (ART): While ART has revolutionised the treatment of HIV and significantly prolonged the lives of those infected, some anti-retroviral medications have been associated with adverse effects on bone health. Certain protease inhibitors and tenofovir-based drugs have been linked to reductions in bone mineral density. However, it’s essential to note that newer generations of anti-retroviral medications have shown fewer negative effects and hopefully will show even less as time and research continues.

Hormonal imbalances: HIV infection can lead to hormonal imbalances, including alterations in sex hormones and Vitamin D levels. Unfortunately, these imbalances can contribute to bone loss. Low levels of testosterone and estrogen, which can occur in both men and women with HIV, have been associated with a decrease in bone density.

Diet and nutrition:HIV can have a variety of effects on all areas of your health, such as maintaining a healthy diet. Factors such as reduced appetite, gastrointestinal issues, and the metabolic effects of the virus can impact bone health by compromising the availability of essential nutrients for bone formation and maintenance, such as calcium, Vitamin D, and protein.

Aging with HIV: As people with HIV age, concerns about bone health have gained prominence. Age-related bone loss is already a natural process, and HIV-associated factors can exacerbate this. This situation places older people living with HIV at a higher risk for osteoporosis and fractures.

Lifestyle:If you add HIV to certain lifestyle factors such as smoking, excessive alcohol consumption, and physical inactivity, you are even more likely to endanger your bones and increase your risk of fractures.

Managing your bone health: Awareness of the impact of HIV has led to greater care being taken by medical practitioners. Routine bone density screenings are highly recommended for all those at high risk. Strategies to maintain bone health include: ensuring adequate calcium and Vitamin D intake; engaging in weight-bearing exercises; quitting smoking; moderating alcohol consumption; and optimising anti-retroviral therapy to minimise bone-related side effects.

It is well to understand that the impact of HIV on bone health is multifaceted and involves a combination of direct viral effects, chronic inflammation, hormonal imbalances, medication side effects, nutritional factors, and lifestyle behaviours. The clear reality is that the interplay of these factors can lead to bone loss, reduced bone density, and an increased risk of fractures among people living with HIV. Considering an holistic approach that integrates bone-focused medical managementtogether with nutritional support, is vital to mitigating the impact of HIV and improving quality of life.

Love your bones. Care for them by caring for yourself, and never forget the vital role they play in living a good and healthy life.

NOFSA (National Osteoporosis Foundation South Africa)

NOFSA is the only non-profit, voluntary health organisation dedicated to promoting lifelong bone health. We focus on reducing the widespread prevalence of osteoporosis while working to find a cure for the disease, and by supporting research and developing programmes of education and advocacy.

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