Your bones are a living tissue that is constantly being broken down and replaced so it is important to know how to keep them strong. Many people living with HIV are at risk from thinning of the bones (osteoporosis) either because of HIV infection itself or some HIV medications. This leads to reduced bone mineral density and increases risk of fracture.
There are other factors that increase the risk of bone loss including smoking, a low body weight, excessive alcohol and low testosterone levels. The risk increase as we age and for women the risk increases with following the menopause.
The good news is there are steps we can take to help improve our bone health.
Eating a balanced diet will ensure that your body obtains enough calcium to maintain strong bones. An adults requires 700mg of calcium per day however if you have osteoporosis or are at increased risk The National Osteoporosis Society recommend an intake of 1200mg per day.
Dairy products, such as milk, yogurt and cheese, provide an important source of calcium as well as protein and phosphorous. If you are vegetarian or vegan make sure you obtain calcium from other sources such as dark green leafy vegetables, beans and pulses, for example baked beans, nuts, dried fruits, fortified soya and tofu products.
To get your recommended 700mg/day have a pint of milk or alternatively 125g (5oz) pot of yogurt, 300ml (1/2pt) semi skimmed milk and 2 sardines on toast.
If you are vegan, include 300ml (1/2pt) calcium fortified rice or soya milk, 5 tablespoons of cooked lentils, a handful of almonds (approximately 25g/1oz) and add a large serving of cooked spinach to your evening meal.
Staying active helps your bones to stay strong. Weight bearing exercise such as walking, dancing, jogging, tennis and golf are good examples of exercise where your muscles are forced to work against gravity. Weight training can also help but lifting and carrying things around the house when you are cleaning or gardening all count.
Being underweight can increase your risk of osteoporosis. if you need to gain weight make sure you do it sensibly and discuss your needs with a dietitian.
Vitamin D is important for calcium absorption. Make sure you include foods such as oily fish, for example, salmon and mackerel, egg yolks, liver, fortified margarine and cod liver oil. However we get most of our vitamin D from sunlight on our skin. In order to safely raise the vitamin D levels in the body it is recommended that you regularly expose your skin for a few minutes around the middle of the day without sunscreen. The more the skin is exposed the better chance of making enough Vitamin D. During winter months in the UK there is no vitamin D synthesis from the sun so it is important to regularly include foods rich in vitamin in the diet.
Salt is thought to speed up the rate at which calcium is lost. Try to reduce or avoid adding salt in cooking and try to add flavour to your foods in other ways such as, using herbs, spices, garlic or lemon juice. For adults, the recommended intake for salt is only 6g per day, the equivalent of approximately 1 teaspoon.
Excessive alcohol consumption is damaging to our bones. Limit your alcohol intake to no more than two-three units per day if you are a woman and no more than three-four units if you are a man. Try to have some alcohol free days every week and avoid binge drinking.
Aim to stop smoking by cutting down on the number of cigarettes you have a day.
For individual advice speak to your HIV dietitian who can provide more detailed advice on ways to increase both calcium and vitamin D in your diet. They may recommend you consider taking supplement tablets.