Osteopenia and osteoporosis in people living with HIV: multiprofessional approach

Figures & data

Table 1 Effects of HIV on osteoblasts and osteoclasts

Bone cell	Effect	Mechanism
Osteoblast	↑ apoptosis ↑ activity ↓ differentiation	TNF-α autocrine/paracrine pathway ↑ calcium deposition and ↓ alkaline phosphatase activity Deviation to the adipose cell line
Osteoclast	↑ differentiation ↓ activity	Upregulation of the macrophage colony-stimulating factor and RANK-L

Note: Adapted from Borderi M Borderi M, Gibellini D, Vescini F, et al. Metabolic bone disease in HIV infection. AIDS. 2009;23(11):1297–1310 with permission of the publisher.²¹

Table 2 General measures for prevention and treatment of osteoporosis

Increased calcium intake (milk and derivatives).

Reduced salt, coffee, and alcoholic drink intake.

Optimization of physical activity.

Exposure to the sun.

Detection and treatment of the associated disease (AIDS).

Table 3 Recommended calcium and vitamin D intake²⁹

Life-stage group	Calcium (mg/day)	Vitamin D (IU/day)
Infants 0 to 6 months	200	400
Infants 6 to 12 months	260	400
1 to 3 years old	700	600
4 to 8 years old	1,000	600
9 to 13 years old	1,300	600
14 to 18 years old	1,300	600
19 to 30 years old	1,000	600
31 to 50 years old	1,000	600
51- to 70-year-old males	1,000	600
51- to 70-year-old females	1,200	600
>70 years old	1,200	800
14 to 18 years old, Pregnant/Lactating	1,300	600
19 to 50 years old, Pregnant/Lactating	1,000	600

Notes: Vitamin D plays an important role in calcium absorption and bone health. It is made in the skin after exposure to sunlight and can also be obtained through the diet. Although many people are able to obtain enough vitamin D naturally, vitamin D production decreases in the elderly, in people who are housebound or do not get enough sun, and in some people with chronic neurological or gastrointestinal diseases. These individuals and others at risk for vitamin D deficiency may require vitamin D supplementation. The recommended daily intake of vitamin D is 400 IU for infants; children, and adults up to age 70 should get 600 IU daily. Men and women age 70 and older should get 800 IU of vitamin D daily. Reprinted with permission from Dietary Reference Intakes for Calcium and Vitamin D, 2011, 2011 by the National Academy of Sciences, Courtesy of National Academies Press, Washington, DC.²⁹

Table 4 Medications used in treating osteoporosis, according to their active agent

Antiresorptive drugs	Bone-forming drugs	Mixed-action drugs
Hormone therapy	Teriparatide	Strontium ranelate
SERMs
Bisphosphonates
Calcitonin

Abbreviation: SERMs, selective estrogen receptor modulators.

BorderiMGibelliniDVesciniFMetabolic bone disease in HIV infectionAIDS200923111297131019550284

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National Academy of SciencesDietary Reference Intakes for Calcium and Vitamin D, 2011Washington DCThe National Academies Press2011 Available from: http://www.niams.nih.gov/Health_Info/Bone/Bone_Health/Nutrition/default.aspAccessed June 9, 2011

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