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Author Topic: how to increase BMD-bone mineral density?  (Read 2462 times)

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Offline friskyguy

  • Member
  • Posts: 105
how to increase BMD-bone mineral density?
« on: September 18, 2013, 12:16:59 PM »
hi all,

Had a DEXA scan a couple of years back and the results came back with a low "T " score and a diagnosis of osteopenia. Doctor changed me from Truvada to Epzicom (Kivezxa) as a result.

I know that maintaining optimal levels of VitD3 and calcium and exercise will assist lessen the decline but looking for some potential additional alternatives to help increase my "T" score by increasing bone density to prevent diminishing bone density as I age.

Has anyone else suffering from low BMD due to the meds or other reasons and can point to more effective remedies to increase bone density?

I read on-line that taking intravenously Zoledronate annually for 2 years lasts for more than 5 years and increases BMD (New Zealand study). Anyone taking these injections or other remedies that have worked?

thanks for any feedback
Frisky
Sero converted Sept '10 / Confirmed + Dec '10
Jan '11, VL 9,500 / CD4 482 (32%)
Feb '11, VL 5,800 / CD4 680 (37%)
start Atripla
Mch '11, VL UD / CD4 700 (42%)
Jun  '11, VL UD / CD4 750 (43%)
swap to Kivexa and Efav. due to osteopenia diag. (DEXA) / kidney issues ( decline in eGFR to 77 )
start supplements - Vit D3 / Omega 3 / multivitamin / mini aspirin
Dec '11,  VL UD <20 /  CD4 670 (49%)  / CD4:CD8 = 1.4
all labs now within normal ranges
Mch '12,  VL UD / CD4 600 (51%)
Sep '12,  VL UD / CD4 810 (51%)
Mch '13   VL UD / CD4 965 (56%)
Sep '13   VL UD / CD4 (not taken)
Dec '13   VL UD / CD4 901 (35%) / CD4:CD8 = 1.1  /  eGFR > 100

Offline buginme2

  • Member
  • Posts: 2,834
Re: how to increase BMD-bone mineral density?
« Reply #1 on: September 18, 2013, 03:47:31 PM »
Low bone density is common for people with HIV and it sounds like your doctor has started you on the proper course of treatment.

Switching off Truvada is often a first step.

Having your vitamin d levels checked and maintained is also a first step.

You should be doing weight bearing exercises (lift weights) regularly.  In addition to regular cardio.

If your numbers continue to decline or don't improve you may want to start an osteoporosis medication such as Boniva (or similar).  Some are one pill per month and some are by IV once a year or so.

Good luck.

Offline aaware72

  • Member
  • Posts: 224
Re: how to increase BMD-bone mineral density?
« Reply #2 on: September 18, 2013, 05:05:25 PM »

You should be doing weight bearing exercises (lift weights) regularly. 


This is very good information.  This is something all people can do to help keep bones strong.
"Yes, knowledge is power. Self-knowledge brings mastery of one's body."

Offline eric48

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  • Posts: 1,117
  • @HIVPharmaCure & tinyurl.com/HIVPharmaCure
Re: how to increase BMD-bone mineral density?
« Reply #3 on: September 18, 2013, 06:58:12 PM »
This is very good information.

It would be if it were substanciated. I am not saying it is wrong nor untrue, I am saying that the above post does not substanciate the claim.

Vit D3 supplementation: I take it in form of oral 100.000 UI 1/month dose. (Rx required)
Once my doc forgot to include in the prescription , so I had some 2000 UI pills at hand, I took them.
He said that 100.000 UI 1/month dose is more efficient than OTC daily

One should not forget that Vit D (same as B) is stored in a cumulative fashion in the liver, so over use is not recommended

See the following pointers

http://www.ncbi.nlm.nih.gov/pubmed/23611825

http://www.ncbi.nlm.nih.gov/pubmed/23072545

http://www.ncbi.nlm.nih.gov/pubmed/22293363

for further info

There is a clinical trial, if my memory is correct, that demonstrate superiority of 100.000 /monthly (oral)  vs ?000/daily oral , but could not find it

When supplementing, proper means of supplementation are required and monitoring as well.

I have not done much further research on this since my BMD came back OK and I am on Kivexa (aka Epzicom) which is not associated to BMD loss (at least not the the extend of TNF)

Currently at : (25OH-D2+D3) ....... 36 ng/ml

Calcium and Phosphate levels should be monitored as well

Hope this helps

eric


Offline aaware72

  • Member
  • Posts: 224
Re: how to increase BMD-bone mineral density?
« Reply #4 on: September 18, 2013, 08:17:51 PM »
It would be if it were substanciated. I am not saying it is wrong nor untrue, I am saying that the above post does not substanciate the claim.

Vit D3 supplementation: I take it in form of oral 100.000 UI 1/month dose. (Rx required)
Once my doc forgot to include in the prescription , so I had some 2000 UI pills at hand, I took them.
He said that 100.000 UI 1/month dose is more efficient than OTC daily

One should not forget that Vit D (same as B) is stored in a cumulative fashion in the liver, so over use is not recommended

See the following pointers

http://www.ncbi.nlm.nih.gov/pubmed/23611825

http://www.ncbi.nlm.nih.gov/pubmed/23072545

http://www.ncbi.nlm.nih.gov/pubmed/22293363

for further info

There is a clinical trial, if my memory is correct, that demonstrate superiority of 100.000 /monthly (oral)  vs ?000/daily oral , but could not find it

When supplementing, proper means of supplementation are required and monitoring as well.

I have not done much further research on this since my BMD came back OK and I am on Kivexa (aka Epzicom) which is not associated to BMD loss (at least not the the extend of TNF)

Currently at : (25OH-D2+D3) ....... 36 ng/ml

Calcium and Phosphate levels should be monitored as well

Hope this helps

eric

Hi Eric,

I was only referring to resistance training part of his post.  :)

"Abstract
Osteoporosis is a major public health problem that is characterized by low bone mass and increased susceptibility to fractures, primarily of the hip, spine, and wrist. It is estimated to cause 1.5 million fractures annually in the United States in people aged 50 yr and older. Physical activity, particularly weight-bearing exercise, is thought to provide the mechanical stimuli or "loading" important for the maintenance and improvement of bone health, whereas physical inactivity has been implicated in bone loss and its associated health costs. Both aerobic and resistance training exercise can provide weight-bearing stimulus to bone, yet research indicates that resistance training may have a more profound site specific effect than aerobic exercise. Over the past 10 years, nearly two dozen cross-sectional and longitudinal studies have shown a direct and positive relationship between the effects of resistance training and bone density. Conversely, a handful of other studies have reported little or no effect on bone density. However, these results may be partially attributable to the study design, intensity and duration of the exercise protocol, and the bone density measurement techniques used. High-intensity resistance training, in contrast to traditional pharmacological and nutritional approaches for improving bone health in older adults, has the added benefit of influencing multiple risk factors for osteoporosis including improved strength and balance and increased muscle mass."

http://www.ncbi.nlm.nih.gov/pubmed/9927006
« Last Edit: September 18, 2013, 08:20:18 PM by aaware72 »
"Yes, knowledge is power. Self-knowledge brings mastery of one's body."

Offline wolfter

  • Member
  • Posts: 4,387
Re: how to increase BMD-bone mineral density?
« Reply #5 on: September 19, 2013, 02:23:44 PM »
I was diagnosed with osteoporosis after my BMD test.  Continual fractures and breaks led to my doctor ordering them.  He is seeing a large number of patients suffering from this in spite of our relative young ages. 

I do know that Truvada can cause bone loss.  I've done 3 doses of Boniva so far and will have another scan after 3 more.  There is not a lot of research in this field yet as middle aged men don't typically suffer this.

I can assure you that inactivity was not the cause of mine.  I don't do strength training, but I am an avid cyclist, runner and walker.
productivity breeds content

Offline Jeff G

  • Administrator
  • Member
  • Posts: 10,819
  • How am I doing Beren ?
Re: how to increase BMD-bone mineral density?
« Reply #6 on: September 19, 2013, 02:32:04 PM »
I was diagnosed with osteoporosis after my BMD test.  Continual fractures and breaks led to my doctor ordering them.  He is seeing a large number of patients suffering from this in spite of our relative young ages. 

I do know that Truvada can cause bone loss.  I've done 3 doses of Boniva so far and will have another scan after 3 more.  There is not a lot of research in this field yet as middle aged men don't typically suffer this.

I can assure you that inactivity was not the cause of mine.  I don't do strength training, but I am an avid cyclist, runner and walker.


Eat a steak .

Offline wolfter

  • Member
  • Posts: 4,387
Re: how to increase BMD-bone mineral density?
« Reply #7 on: September 19, 2013, 02:33:52 PM »
Eat a steak .

What does steak have to do with it? :o
productivity breeds content

Offline Miss Philicia

  • Member
  • Posts: 23,899
  • celebrity poster, faker & poser
Re: how to increase BMD-bone mineral density?
« Reply #8 on: September 19, 2013, 03:47:25 PM »
What does steak have to do with it? :o

Honey, we all know you live off of a diet of hot water, cucumbers and celery. Of course you don't have any firm bones.
"Ive slept with enough men to know that Im not gay"

Offline sfpvguy41

  • Member
  • Posts: 115
Re: how to increase BMD-bone mineral density?
« Reply #9 on: September 20, 2013, 02:24:38 AM »
Hi Frisky:
I was a bit unsure from your post why if you were told a couple of years ago you had osteopenia that you are just asking now for advise?  Have you been checked since?  Usually those of us with problems are told to get a DEXA scan every year.

I have osteoporosis, it was pretty bad.  I decided to hit it from all angles:
1) D3 supplementation, my levels were low, it takes a lot to make a difference, for me 50k/month
2) I was also switched from Truvada to Epzicom, and my numbers in general got better so was glad I did
3) calcium supplementation (also be sure you get enough Vit K and Magnesium, there are supplements that combine all of these)
4) check testosterone levels, if they are low that can be a cause too
5) biophosphenates (Boniva etc)...I take one a week. What they do is slow the breakdown of the bones
6) strontium supplementation.  Google it: it's the next periodic element after calcium, but not well known in the US.  You can find a lot on the livestrong site and others about osteoporosis.  It is the preferred treatment, apparently in Europe over biophosphenates, as it is supposed to help build new bone not just prevent breakdown.  As such you can combine  Strontium supplementation with your Boniva and hit it from both sides (but you can't take it at the same time of day as Calcium).
7) weight bearing excercise, as mentioned
8) minimize drinking and don't smoke, both damage bone density

I did all of these things and after one year raised my bone density by 7% the first year, and 4% the second.  I am now well into the third and hope by the next annual DEXA I will get out of the osteoporosis range.

Which leads me to the last point, bones change slowly.  The 7% improvement was, according to my doctor and the DEXA scan technologist, about as good as it gets in a year.  So it takes years to improve, but it can be improved.

I wish that other HIVers would get scans as a routine, because I wish I had known before it got so bad, but am thankful the Doc sent me for a scan before I had any fractures.  I recommend everyone get those scans because once you've broken something, it's too late.

Good luck.
Labs: (undetectable since 2005)
12/13: 634 cdr, 37.3%, 758 cd8, total chol 183, triglycerides 131
8/13: changed to Edurant from Reyataz
12/12: 828 cd4, 34.5%, 1078 cd8, total chol 192, tri 196
12/11: 787 cd4, 37%, 979 cd8.
9/11: 758 cd4, 38%, 944 cd8, und.
8/11 dropped norvir, incr reyataz to 400 mg
6/11: 621 CD4 CD4% 41, CD8 680! Undetectable. Creatinine and eGFR are ok now.
Switched from Truvada to Epzicom in late April 2011
AGT/AST and creatinine back to normal mid-April.
Cut Norvir from regimen.
Switched back to Reyataz/Norvir late Feb 2011
2/11: CD4 664 34%, CD8 963, diagnosed with osteoporosis, high AGT/AST and creatinine.
12/10: CD4: 676 CD4%: 34 CD8: 1012
Switched from Reyataz/norvir to Isentress 10/10
8/10: CD4: 731 CD4%: 40 CD8: 866
Diagnosed Sept. 2002 started meds May 2005.

Offline wolfter

  • Member
  • Posts: 4,387
Re: how to increase BMD-bone mineral density?
« Reply #10 on: September 20, 2013, 07:41:01 PM »
Honey, we all know you live off of a diet of hot water, cucumbers and celery. Of course you don't have any firm bones.

I have at least one firm bone.   8)  And eating celery to stay thin is usually reserved for bulimics.  I prefer salads and protein bars.
productivity breeds content

Offline GoForIt

  • Member
  • Posts: 94
Re: how to increase BMD-bone mineral density?
« Reply #11 on: September 20, 2013, 10:04:21 PM »
Hi Frisky:
I was a bit unsure from your post why if you were told a couple of years ago you had osteopenia that you are just asking now for advise?  Have you been checked since?  Usually those of us with problems are told to get a DEXA scan every year.

I have osteoporosis, it was pretty bad.  I decided to hit it from all angles:
1) D3 supplementation, my levels were low, it takes a lot to make a difference, for me 50k/month
2) I was also switched from Truvada to Epzicom, and my numbers in general got better so was glad I did
3) calcium supplementation (also be sure you get enough Vit K and Magnesium, there are supplements that combine all of these)
4) check testosterone levels, if they are low that can be a cause too
5) biophosphenates (Boniva etc)...I take one a week. What they do is slow the breakdown of the bones
6) strontium supplementation.  Google it: it's the next periodic element after calcium, but not well known in the US.  You can find a lot on the livestrong site and others about osteoporosis.  It is the preferred treatment, apparently in Europe over biophosphenates, as it is supposed to help build new bone not just prevent breakdown.  As such you can combine  Strontium supplementation with your Boniva and hit it from both sides (but you can't take it at the same time of day as Calcium).
7) weight bearing excercise, as mentioned
8) minimize drinking and don't smoke, both damage bone density

I did all of these things and after one year raised my bone density by 7% the first year, and 4% the second.  I am now well into the third and hope by the next annual DEXA I will get out of the osteoporosis range.

Which leads me to the last point, bones change slowly.  The 7% improvement was, according to my doctor and the DEXA scan technologist, about as good as it gets in a year.  So it takes years to improve, but it can be improved.

I wish that other HIVers would get scans as a routine, because I wish I had known before it got so bad, but am thankful the Doc sent me for a scan before I had any fractures.  I recommend everyone get those scans because once you've broken something, it's too late.

Good luck.

Thanks for this information.  Very informative post.
08/09/2013   Diagnosed WB positive
08/20/2013   CD4-506(28%)  VL-10,800
09/12/2013   CD4-391(28%)  VL-14,900
09/17/2013   Start ART (Truvada & Tivicay)
10/11/2013   CD4-377(26%)  VL-UD
12/20/2013   CD4-590(??%)  VL-UD
03/18/2014   CD4-660(29%)  VL-UD
07/22/2014   CD4-613(29%)  VL-UD

Offline friskyguy

  • Member
  • Posts: 105
Re: how to increase BMD-bone mineral density?
« Reply #12 on: September 22, 2013, 05:41:04 AM »
Thanks guys for taking the time to reply and thanks to Sfpvguy41 for his great post.

To Sfpvguy41.....only have had one Dexa scan and the results were not that good. I was only told to maintain my Calcium and VitD3 levels.....they were at optimal levels and was told to come back in a couple of years or so......this advice was not from a western doc however.

Just wanting to be more pro-active and looking to find some alternatives to help me build bone density instead of resigning to the fact of gradual decline into osteoporosis territory.

Thanks a million for your suggestions.
Sero converted Sept '10 / Confirmed + Dec '10
Jan '11, VL 9,500 / CD4 482 (32%)
Feb '11, VL 5,800 / CD4 680 (37%)
start Atripla
Mch '11, VL UD / CD4 700 (42%)
Jun  '11, VL UD / CD4 750 (43%)
swap to Kivexa and Efav. due to osteopenia diag. (DEXA) / kidney issues ( decline in eGFR to 77 )
start supplements - Vit D3 / Omega 3 / multivitamin / mini aspirin
Dec '11,  VL UD <20 /  CD4 670 (49%)  / CD4:CD8 = 1.4
all labs now within normal ranges
Mch '12,  VL UD / CD4 600 (51%)
Sep '12,  VL UD / CD4 810 (51%)
Mch '13   VL UD / CD4 965 (56%)
Sep '13   VL UD / CD4 (not taken)
Dec '13   VL UD / CD4 901 (35%) / CD4:CD8 = 1.1  /  eGFR > 100

Offline eric48

  • Member
  • Posts: 1,117
  • @HIVPharmaCure & tinyurl.com/HIVPharmaCure
Re: how to increase BMD-bone mineral density?
« Reply #13 on: September 22, 2013, 10:11:11 PM »
... but it can be improved.


That is good to know... Thanks fo sharing Eric

Offline sfpvguy41

  • Member
  • Posts: 115
Re: how to increase BMD-bone mineral density?
« Reply #14 on: September 23, 2013, 01:26:41 AM »
I'm glad my trials can help someone else. i wish DEXA scans were more common for younger HIVers (at least by 5 yrs after diagnosis, not by age). It's worth knowing, so you can be proactive.

Labs: (undetectable since 2005)
12/13: 634 cdr, 37.3%, 758 cd8, total chol 183, triglycerides 131
8/13: changed to Edurant from Reyataz
12/12: 828 cd4, 34.5%, 1078 cd8, total chol 192, tri 196
12/11: 787 cd4, 37%, 979 cd8.
9/11: 758 cd4, 38%, 944 cd8, und.
8/11 dropped norvir, incr reyataz to 400 mg
6/11: 621 CD4 CD4% 41, CD8 680! Undetectable. Creatinine and eGFR are ok now.
Switched from Truvada to Epzicom in late April 2011
AGT/AST and creatinine back to normal mid-April.
Cut Norvir from regimen.
Switched back to Reyataz/Norvir late Feb 2011
2/11: CD4 664 34%, CD8 963, diagnosed with osteoporosis, high AGT/AST and creatinine.
12/10: CD4: 676 CD4%: 34 CD8: 1012
Switched from Reyataz/norvir to Isentress 10/10
8/10: CD4: 731 CD4%: 40 CD8: 866
Diagnosed Sept. 2002 started meds May 2005.

Offline Valmont

  • Member
  • Posts: 332
Re: how to increase BMD-bone mineral density?
« Reply #15 on: September 24, 2013, 08:29:31 PM »
This post is great, thank you for the question and for the answers, this is also very useful for me, I did think it was possible to re-gain lost bone density, in my case, it seems I loose part of it because of bad food habits last years (it is too son for my meds to generate me this kind of problem...)

I was taking 200 UI of vit D a day (I was living in Ecuador), but I just moved to Canada, I think it is low ; I probably wont see any doc till the end of the year and those I know dont know about North American reality.  How much do you usually take in low sun countries?
Apr 2011: Diagnotized
Jun 2011: CD4: 504  VL: 176.000
Dic 2011: CD4: 714  VL: 95.000
May 2012: CD4: 395 VL: 67.000
Jun 2012: CD4: 367
Agu 2012: Starting Emtricitabine 200 mg / Tenofovir 300 mg and Efavirenz 600 mg (2 pills) different brands or VIRADAY/ATRIPLA/Mylan....
Sep 2012: VL: 138
Dic 2012: CD4: 708 VL: <34  %CD4: 32%
Jan 2013: CD4: 707 VL: <20
May 2013: CD4: 945 VL: <34 %CD4: 33%
Agu 2013: CD4: 636 VL: <34 %CD4: 50%
Dic 2013: Latent TB, started Isoniazid

Offline wolfter

  • Member
  • Posts: 4,387
Re: how to increase BMD-bone mineral density?
« Reply #16 on: September 25, 2013, 10:38:55 AM »
There is an interesting article in Poz Magazine in which they surveyed HIV + folks about what tests their doctors have ordered.  Only 20 some percent indicated BMD test were suggested.

I wish I would have had one years ago to determine a base line.  The cause/affect is pretty difficult to determine.  Could it be medication, diet or lifestyle? 
productivity breeds content

Offline Valmont

  • Member
  • Posts: 332
Re: how to increase BMD-bone mineral density?
« Reply #17 on: September 25, 2013, 11:38:21 AM »
Ive done mine by my own, after talking with my girl friend, she is a doc, I had 4 fractures in a year in 2013 when I had never have one in my life, she thought it would have gone back normal and I would have stopped bothered and freaked...  and it came back with an osteopenia diagnostic !

It is not that expensive, I think it can be a good thing to do it as a line base (I paid 20 USD) before starting treatment.  If I would have done it in the future, sure I would have guilted my medecine...

My girlfriend says osteopenia is more commun tan one imagine, particularly in countries where there is less sun like Europe or North America, and because of the way of life and food...  In my case, I definitively ate wrongly.  Most of the bone mineralisation makes till 20 years old, then it start decreasing quicker or slowler depending of you habits.

I believe it is just the same as HIV, sooner you detect it, sooner you can act and change your habits and treat it, to avoid bigger problems...
Apr 2011: Diagnotized
Jun 2011: CD4: 504  VL: 176.000
Dic 2011: CD4: 714  VL: 95.000
May 2012: CD4: 395 VL: 67.000
Jun 2012: CD4: 367
Agu 2012: Starting Emtricitabine 200 mg / Tenofovir 300 mg and Efavirenz 600 mg (2 pills) different brands or VIRADAY/ATRIPLA/Mylan....
Sep 2012: VL: 138
Dic 2012: CD4: 708 VL: <34  %CD4: 32%
Jan 2013: CD4: 707 VL: <20
May 2013: CD4: 945 VL: <34 %CD4: 33%
Agu 2013: CD4: 636 VL: <34 %CD4: 50%
Dic 2013: Latent TB, started Isoniazid

Offline elf

  • Member
  • Posts: 596
Re: how to increase BMD-bone mineral density?
« Reply #18 on: September 28, 2013, 03:48:09 PM »
Melatonin stimulates osteoblasts.  ;)
Let's have a Kiki!

Offline elf

  • Member
  • Posts: 596
Re: how to increase BMD-bone mineral density?
« Reply #19 on: September 28, 2013, 05:22:41 PM »
Antidepressants are bad for your bones:

Quote
Selective serotonin reuptake inhibitors inhibit human osteoclast and osteoblast formation and function

CONCLUSIONS:
These data demonstrate that SSRIs differentially inhibit bone cell function via apoptosis. This may explain the mechanisms of bone loss with chronic use and aid clinical choices.

http://www.ncbi.nlm.nih.gov/pubmed/?term=Selective+serotonin+reuptake+inhibitors+inhibit+human+osteoclast+and+osteoblast+formation+and+function
Let's have a Kiki!

 


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