One for the Ladies (but yes, you all may peek)

[emeraldize]

In case you have not read Tim's article regarding osteoporosis/osteopenia, I've copied it here. Greater Risk of Bone Loss in HIV-Positive Women

By Tim Horn, Senior Writer & Editor, AIDSmeds.com

A report published in the August issue of The Journal of Clinical Endocrinology and Metabolism has confirmed that HIV-positive women are more likely to suffer from low bone mineral density (BMD) compared to HIV-negative women. However, the study also suggests that the bone loss in HIV-positive women does not appear to significantly worsen over time and is often related to traditional risk factors, including low body weight and cigarette smoking.

Osteoporosis and osteopenia are familiar terms to many older adults. A diagnosis of osteoporosis, a serious loss of BMD, can bring on a lot of anxiety, as it generally means that a person's bones have become weaker and are more likely to break. And while a diagnosis of osteopenia, a less serious loss of BMD, does not mean the same thing as an osteoporosis diagnosis, it can be of concern just the same.

Previous studies have reported increased rates of osteopenia and osteoporosis among HIV-positive people. However, most of these studies were "cross sectional" in their design, meaning that they relied on a one-time "snapshot" of all patients enrolled and didn't follow patients to see if the problem worsened. What's more, the studies were generally too small to evaluate the risk factors for decreased BMD in the HIV-positive volunteers.

In the newest study, conducted at Harvard Medical School in Boston, changes in BMD among 100 HIV-positive women – compared to 100 HIV-negative women similar in age and race – were monitored over a two-year follow-up period.

Dual energy X-ray absorptiometry (DEXA) scans, used to measure BMD, were conducted in all of the study volunteers upon entry and every six months for a total of 24 months.

At the start of the study, the HIV-positive women had significantly lower BMD at three important skeletal locations: the spine, the hip, and the femoral neck (the ball part of the hip joint). The differences between the two groups were statistically significant, meaning that the differences in BMD between to two groups weren't likely due to chance.

Approximately 41% of the HIV-positive women had osteopenia and 7% had osteoporosis. Oddly, the paper did not summarize rates of osteopenia or osteoporosis in the HIV-negative women for comparison purposes.

While the differences between the HIV-positive and HIV-negative women persisted for two years, BMD actually remained stable in both groups of women. This stability, the Harvard group pointed out, argues against worsening bone loss in HIV-positive women compared to HIV-negative controls.

Blood markers of bone metabolism – notably osteocalcin and N-telopeptide of type 1 collagen – were higher in HIV-positive women compared to HIV-negative women.

Bone metabolism is better known as "remodeling," with two important types of bone cells to be familiar with: osteoclasts and osteoblasts. Osteoclasts are responsible for removing old or worn bone, which can leave cavities (lacunas). The removal of bone, and the creation of lacunas, is known as bone resorption. It is the job of the osteoblasts to fill these lacunas with new collagen and mineral, a process known as bone formation.

Just as healthy bone structure requires adequate amounts of collagen and mineral, there must also be a healthy balance of bone resorption and formation. If the amount of new bone deposited by osteoblasts equals the amount of bone taken away by osteoclasts, the bones stay strong. However, the Harvard research suggests that the bone resorption and formation seems to prematurely shift in HIV-positive women, resulting in more bone being taken away than deposited.

Many of the risk factors for low BMD were not directly related to HIV, including low body weight, smoking history, low vitamin D levels, and high levels of bone metabolism markers. However, the longer women had been infected with HIV or had been treated with at least one nucleoside reverse transcriptase inhibitor (NRTI), the greater the association with decreased BMD.

Based on these findings, the study authors concluded that HIV-positive women with easy-to-document risk factors for bone loss, including low body weight and blood markers of bone metabolism, should be screened for bone loss with DEXA scanning.
 

[Matty the Damned]

I peeked!

MtD
(Who often looks through keyholes)

[bear60]

Well guess what... HIV positive men are at risk too. My hubby, poor dear, had to endure sitting in a waiting room of 70 to 80 something women, he being the only male...... and 47. Yes he has lost bone density....yes he has osteoporosis.

[david25luvit]

I did more than peek.........

I subscribed to the magazine.............

[IzPoz]

After mentioning to my doctor about my workout routine, he was very happy.  He told me that resistance training (even if in the measure to just tone your muscles) is good to help prevent osteoperosis.  He told me that it helps to promote or stimulate bone growth.

Not that it will make me taller than my 5', but I'm hoping it will help prevent a diagnosis such as osteo.

Now I want to go back to bed, but I have to get in the shower and get ready for work

[Moffie65]

Thanks Emerald,

I want to make sure that this is also true in men, however, not unlike the new vaccine for HPV, the studies are done in one gender and then the science cannot say that it is a situation for both men and women.  I think that this does not serve the society or the medical community well, as it negates the obvious, that both men and women can and do, suffer the same events from the same illnessses.

I know if I didn't already have HPV, I would demand the vaccine for my own good health, but then you would have to find a doctor that would have a mind open enough to realize that HPV is not unlike HIV in that it is just a virus, and it can affect both men and women.

OK, enough of my rant.  Thanks for the information.

IN LOve and Support.

[Tim Horn]

Hi gang...

Anne, I think it's great that you highlighted this research.  If anything, it definitely underscores the need for HIV-positive women to at least discuss their bone mineral density with their healthcare providers.

As for men, well, there hasn't been a whole lot of research into osteopenia/osteoporosis.  Experts suggest that HIV-positive men are at a higher risk of osteopenia and osteoporosis compared to age-matched HIV-negative men, but there simply hasn't been enough research illustrating how much more common it really is.  Much of what we do know about osteopenia/osteoporosis in HIV comes from studies involving women. 

Interestingly, there was an article published by Dr. Mark Bolland in the August issue of Clinical Endocrinology -- the same month the women's study was published -- suggesting that BMD is not reduced in HIV-positive men being treated with antiretroviral therapy (compared to HIV-negative controls).  While hip BMDs were slightly lower in the HIV-positive subjects, this was tied to low pre-treatment body weight -- one of the main risk factors for osteopenia/osteoporosis in the Harvard study involving HIV-positive women. 

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2265.2006.02572.x


In another study conducted by Sydney's Dr. Andrew Carr and his colleages, approximately 22% of the 221 HIV-positive men evaluated had osteopenia, whereas 3% (a very low percentages, actually) has osteoporosis.  Here, too, low pre-treatment body weight was considered to be a major factor, along with increased lactic acid levels (likely caused by nucleoside reverse transcriptase inhibitor therapy). 

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=11371684&query_hl=4&itool=pubmed_docsum

I think it's important to stress a common misconception: that osteopenia is the same as osteoporosis.  While both conditions mean that bone density is less than that of normal bone, only osteoporosis is associated with a significantly increased risk of bone fracture.

Whereas a diagnosis of osteoporosis reflects bone disease, a diagnosis of osteopenia is primarily meant to draw attention to decreasing bone density – that might eventually progress to osteoporosis – and the importance of maintaining bone health. Most experts agree that osteopenia is not a cause for alarm and does not usually need to be treated, with the exception of more attention being paid to calcium and vitamin D intake (if deficiencies can be documented via a blood test), along with exercise.

While it is true that men and women diagnosed with osteopenia are at a higher risk of developing osteoporosis over a five- to ten-year period, only a percentage of people with osteopenia will eventually develop osteoporosis and experience a serious fracture.

There's additional information to consider: even though rates of osteopenia and osteoporosis are higher in HIV-infected people, studies have not found that HIV-positive people are experiencing serious bone fractures at a higher rate than their age-matched HIV-negative peers.    A likely reason for this is that many HIV-positive people with osteoporosis are significantly younger (and therefore stronger, more agile, and have greater dexterity) than older (HIV-negative) patients with osteoporosis who have essentially defined what we think we know about osteoporosis and the risk of serious bone fractures.  What's more, the osteopenia seen in post-menopausal (HIV-negative) women seems progressive, whereas the osteopenia seen in pre-menopausal HIV-positive women -- as was demonstrated in the Harvard study -- does not appear to progress significantly with time.  In other words, a diagnosis of osteopenia -- or a diagnosis of osteoporosis -- in a younger HIV-positive women or man may not really be the same as a diagnosis of osteopenia or osteoporosis in an older woman or man. 

Tim Horn   

[poobear]

Thanks for the info.  I will check into it being my mother also has osteoporosis, not sure if it is genetic to?  But again thanks for info     Rachel