Side Effects of HIV Medicines

Osteoporosis is a bone disease that weakens the bones and increases the risk of fractures. While the risk of fractures increases throughout the body in people with osteoporosis, the risk is most noticeable in the hips, spine, and wrists. A milder form of bone loss is known as osteopenia.

There is a clear link between HIV infection, some HIV-related medicines, and bone loss. If untreated, prolonged bone loss could result in osteoporosis. 

There are many risk factors for osteoporosis. Some risk factors cannot be changed, while others can be controlled by lifestyle choices.

Risk factors for osteoporosis that cannot be changed include:

• Age: The risk of osteoporosis increases as people get older.
• Gender: Compared to men, women have smaller bones and lose bone faster due to hormonal changes after menopause.
• Race and ethnicity: The risk of osteoporosis is greatest for White and Asian women.
• Family history: Osteoporosis tends to be genetic.

The following risk factors for osteoporosis can be controlled by lifestyle choices:

• Poor diet: A diet low in calcium and vitamin D increases the risk of osteoporosis.
• Physical inactivity: Physical inactivity tends to weaken bones.
• Smoking: Smoking increases the risk of osteoporosis.
• Alcohol: Too much alcohol can cause bone loss and broken bones. 

Certain HIV medicines, such as tenofovir disoproxil fumarate (TDF), have been linked to bone loss. In contrast, vitamin D and calcium supplements can increase bone mineral density in participants taking TDF-based drugs. If your doctor suspects that TDF or another HIV medicine is lowering your bone density, they may switch you to another HIV medicine.

Bone loss that leads to osteoporosis generally occurs without symptoms. The first sign of osteoporosis is often a broken bone after a minor fall. Osteoporosis can also cause tiny fractures in your spine that cause back pain.

A bone mineral density test (also called dual-energy x-ray absorptiometry) is used to measure bone health. This painless test is used to diagnose osteopenia and osteoporosis.

If you have HIV, you may want to discuss bone mineral density testing with your health care providers while also taking precautionary steps to prevent osteoporosis.

You can take the following steps to prevent osteoporosis:

• Eat a healthy diet rich in calcium and vitamin D. Calcium-rich foods include milk, dairy products, broccoli, sardines, tofu, and almonds. Meanwhile, milk, egg yolks, saltwater fish, and liver are high in vitamin D. Alternatively, you can also take calcium and vitamin D supplements. 
• Stay active. Weight-bearing physical activities, such as walking and lifting weights, can make bones stronger and help slow down bone loss. 
• Do not smoke. Smoking is associated with bone density loss and increases the risk of broken bones the longer and more often you smoke.
• Cut down on alcohol. If you drink alcohol, drink in moderation. Too much alcohol can damage bones and increase the risk of falling.

Osteoporosis treatment includes regular exercise and eating a healthy diet that is rich in calcium and vitamin D. While there are also medicines to help prevent and treat osteoporosis, lifestyle choices are essential to long-term bone health.

People with osteoporosis should also take measures to avoid falls that can lead to broken bones. For example, they may use a cane or walker to help prevent such accidents.

For people with HIV, regular bone density testing could help reduce the risk of osteoporosis. If you have HIV and believe you are at risk for osteoporosis, be sure to consult with your health care provider in case a change to your treatment regimen is necessary. 

From the National Institute of Arthritis and Musculoskeletal and Skin Diseases:

• Osteoporosis Causes and Symptoms
• Bone Health and Osteoporosis

From the NIH Office of AIDS Research: 

• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV: 

  • Adverse Effects of Antiretroviral Agents 

  • Poor CD4 Cell Recovery and Persistent Inflammation Despite Viral Suppression

From MedlinePlus:

• Exercise, Lifestyle, and Your Bones

From the Office on Women's Health

• Osteoporosis

Also see the HIV Source collection of HIV links and resources.