How HIV Affects Your Bones

Medically Reviewed by Carmelita Swiner, MD on August 03, 2022
3 min read

Your bones tend to get weaker as you get older. That may be especially true if you have the human immunodeficiency virus (HIV). The virus, which causes AIDS, itself may make your bones more likely to break. And some anti-HIV medications may raise your chances for bone loss.

Your bone isn’t all solid. Instead, it’s living tissue mostly made up of honeycomb-like scaffolding filled with fluids. As you age, your body may stop growing new bone fast enough to fully replace old bone.

Over time, that can cause your bones to become fragile. If you lose too much bone mass, or density, your doctor may diagnose you with osteoporosis. A smaller level of bone loss is called osteopenia.

About half of all people with HIV will get osteoporosis or osteopenia. They’re also at least twice as likely to break a bone as those who don’t have the virus. Many things may play a role in raising the risk of low bone density and fractures, including:

People who are HIV-positive are more likely to have risk factors for bone loss, including smoking, drinking alcohol, use of opioids, low testosterone, and a lower intake of calcium and vitamin D.

The virus itself may play a role. Some studies have shown a link between HIV and bone loss. And problems like bone fractures may be more common as your HIV disease gets more severe.

Certain HIV drugs may weaken bones. In studies, the drug tenofovir disoproxil fumarate has been linked to bone loss. A group of HIV drugs called protease inhibitors also are being studied, but their bone risk is less clear.

HIV-positive people are aging. Thanks to many effective drugs, almost half of Americans living with HIV are 50 years or older. Even without HIV, you’re likely to be losing bone by the time you reach your 40s or 50s. For women, bone loss happens fastest in the first few years after menopause.

Osteoporosis is often called a silent disease because you may not know you have a problem until you break a hip or wrist. And the condition tends to run in families.

Still, you can take steps to better protect your bones:

  • If you smoke, quit.
  • Drink alcohol in moderation or not at all.
  • Stay active and exercise. Activities like walking and weightlifting make bones stronger.
  • Eat foods high in calcium or vitamin D, like yogurt, nuts, tofu, broccoli, egg yolks, and cheese.

Ask your doctor if calcium or vitamin D supplements may be right for you.

A bone mineral density test is usually recommended for people with HIV when you reach menopause if you’re female, or after age 50 if you’re male. The test compares your bone’s strength against that of healthy young adults. Your score will show if you have osteoporosis or osteopenia.

In general, treatment for osteoporosis for people with HIV is not different than for other people. Your doctor may recommend lifestyle changes and correcting any vitamin D deficiency.

If you have osteoporosis, your doctor may prescribe a type of drug called a bisphosphonate that may halt more bone loss. Women who plan to have children should not take it. Most people don’t take bisphosphonate for longer than 5 years because of long-term side effects.