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Osteonecrosis and AVN
vitamin D (and spending some time in the sunshine) protect you against bone mineral loss.
Osteonecrosis and AVN are much less common, and usually affects the hip, shoulder or knee joints, and requires replacement surgery. It is very common for corticosteroid use to be a contributing factor in cases of AVN. Early diagnosis of AVN makes a big difference to the success of treatment as well as your quality of life. If you have pain in these joints, ask to see a specialist. An MRI scan is used to make an appropriate diagnosis.
Protecting bones: treatment and prevention Your bones are a living structure, 10% of which naturally die each year to be replaced by new cells. If the bone isn’t replaced quickly enough or in sufficient quantities, your bones become thinner and more brittle. Leading an active life, and including exercise, maintains healthy bone. This includes weight-bearing exercise (walking, jogging, running, steps and dancing) and muscle strengthening exercise. Improvements include better posture, balance and strength and a direct improvement in bone density. Exercise with twisting and stretching may not be recommended if you have osteoporosis - always check first. Treatment and prevention measures are similar to HIV negative people - although closer monitoring of HIV positive people is clearly important. Stopping smoking and reducing alcohol, taking exercise and eating a diet adequate in calcium, protein and July 2012
Bone-building nutrients include calcium and vitamin D3 (cholecalciferol) and any deficiency should be corrected by increasing dietary intake or use of supplements. Guidelines recommend adult targets using 1200 mg daily for calcium and 800 -1000 IU/day for vitamin D3 (for people at higher risk). If you have very low levels (<15 nmol/L) then using higher doses (50,000 IU weekly) for the first few months is recommended. These nutrients can be prescribed by your doctor and sometimes require special monitoring and dosing. The target for vitamin D is for blood levels of 25(OH)D to be higher than 75 nmol/L. Although HIV meds may have a small negative impact on bone strength, the other benefits of treatment usually outwieght this small risk. First-line medications to improve bone mineral density are a family of drugs called bisphosphonates. These include alendronate (Fosamax) and zoledronate (Zometa). These may only be needed for a few years until a treatment response is achieved.
Links
National Osteoporosis Foundation (US) www.nof.org National Osteoporsis Society (UK) www.nos.org.uk/ Bone Research Society www.brsoc.org.uk 89