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Aging & Bone Disease in HIV
 
 
  http://newamericamedia.org/2010/10/a-doctors-word-reducing-hivs-bone-breaking-risk.php
 
New America Media, News Report, Erin Marcus, MD, Posted: Oct 27, 2010 At the age of 56, Jules Levin felt pretty invincible, despite being HIV positive. He went to the gym regularly and controlled his disease well by taking his antiretroviral medicines every day.
 
Then he slipped one day while on vacation and broke his wrist.
 
Levin underwent an operation to insert pins in his bones and needed to wear a cast for a month, keep his arm elevated and then do physical therapy for two months to get to the point where he could lift a five-pound weight.
 
"It was one of the most difficult things I've ever been through in my life," Levin said. "I ran and biked and lifted weights, and now all of a sudden I couldn't turn the page of a newspaper. It just really got to me."
 
After a few simple tests, the reason for Levin's fracture became clear: His bones were weak from osteoporosis, a disease that's most commonly seen in older women, but that's also associated with HIV.
 
"The giddiness of the age of HAART is over," said Levin, referring to the acronym for highly active antiretroviral therapy. That's the life-saving drug regimen prescribed to people with HIV.
 
"We should have an aging clinic in every hospital that's serving HIV patients," Levin noted.
 
HIV Hastens Ailments of Aging
 
Osteoporosis is one of many conditions associated with old age that are now being seen with increasing frequency in people with HIV. Research suggests that long-term exposure to the virus-and the inflammation it triggers-makes people vulnerable to premature aging and a host of conditions related to later life, such heart and kidney disease, dementia and osteoporosis.
 
Additionally, the overall population of people with HIV is getting older, thanks to improved medical therapy. At present, one in four people with HIV is age 50 or older.
 
The U.S. Senate Special Committee on Aging has predicted that half of all adults with HIV will be older than 50 by the year 2015. In recent years, the National Institute of Health has increased its funding for research on HIV and aging, and the White House will host a conference on October 27 on HIV and aging.
 
"The evidence is pretty clear," said Levin, who directs NATAP, the National AIDS Treatment and Advocacy Project, a New York-based HIV education and advocacy group. "We're going to see early frailty, early senescence, and people [with HIV] are going to start dying at earlier ages."
 
Actions You Can Take
 
Compared with other conditions associated with HIV and aging-which include cognitive impairment and heart disease-osteoporosis is relatively straightforward to forestall and treat.
 
To maintain bone strength, it's important for all people with HIV to make sure they are consuming an adequate amount of calcium and Vitamin D. A recent article in the journal Clinical Infectious Diseases (http://www.ncbi.nlm.nih.gov/pubmed/20839968) recommends 1,000-1,500 mg. of calcium and 800 to 1,000 International Units of Vitamin D daily, as well as at least 30 minutes of weight-bearing exercise, such as jogging or walking, at least 3 days a week.
 
Calcium is plentiful in dairy products and sardines and is available in supplements such as calcium carbonate and calcium citrate. The National Institutes of Health has an online sheet listing ways to get calcium (http://ods.od.nih.gov/factsheets/calcium/). It's also important to avoid smoking and heavy alcohol use, because these can trigger osteoporosis.
 
HIV is thought to be associated with osteoporosis for a variety of reasons. The infection itself causes inflammation, which in turn affects the cells that maintain bones.
 
Also, many conditions common in people with HIV, such as Vitamin D deficiency, being underweight and low testosterone are associated with osteoporosis. Antiretroviral therapy and other medications frequently prescribed to people with HIV, such as prednisone, also cause bone loss.
 
Even though many antiretrovirals can cause bone loss, osteoporosis is not a reason to stop taking them. "Antiretroviral therapy is life-saving, and we know that stopping antiretroviral therapy is not a good strategy for preventing complications," said Todd Brown, an endocrinology specialist at Johns Hopkins University, who co-wrote the Clinical Infectious Diseases article.
 
Brown and his co-authors recommend that all HIV-positive men over 50 and women who are past menopause undergo testing for osteoporosis, because it's a condition that usually doesn't show symptoms until the person breaks a bone.
 
"Alarmingly" High Among Blacks
 
Brown's own research has found that osteoporosis is "alarmingly" prevalent among African-Americans in inner city Baltimore.
 
"Because of the perception that osteoporosis is a white disease, people of color get short shrift for screening," he said. "This concept that African-Americans are protected shouldn't be a reason to neglect them."
 
Once someone is diagnosed with osteoporosis, it's important to take action to prevent falling, such as by removing clutter and scatter rugs from the floor.
 
Physical therapy can help improve strength and balance, which also reduce the risk of a fall. People also should get their vision checked and review their medication list-including both prescription and over-the-counter drugs--with a doctor to try minimizing drug side effects or interactions that might cause drowsiness or unsteadiness.
 
A class of medicines called bisphosphonates can improve bone strength, but have some rare risks. "While they do decrease the risk of fracture, they're not totally benign drugs," Brown said. "On the flip side, you shouldn't not use them in the patient who is at high risk of a fracture."
 
Levin urges all people with HIV to be assertive about discussing osteoporosis and other age-related conditions with their doctor.
 
"My guess is that 90 percent of patients know nothing about any of this, and a lot of clinicians and case managers don't know about it either," he said. "Every patient should ask their clinician, 'Are you aware? Are you monitoring me for heart disease, diabetes, bone disease, cognitive impairment, kidney disease?' This is an important issue for everybody."
 
 
 
 
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