Supplements for Bone Health: A Special Note for People with HIV

Bone health has been a growing concern for people with HIV, since studies have indicated that HIVers experience higher than expected rates of osteopenia (bone mineral density lower than normal) and osteoporosis (bone mineral density very low, with heightened risk of fractures). A 2012 review from Johns Hopkins researchers, for example, concluded that the “increasing prevalence of osteoporosis in HIV-infected persons translates into a higher risk of fracture, likely leading to excess morbidity and mortality as the HIV-infected population ages.”

The Johns Hopkins study urged more attention to Vitamin D deficiency and supplementation as one way to counter these HIV-related bone issues. But we think it’s also worth looking at recent Canadian research, not focused especially on people with HIV, but with some striking findings about the value of multiple supplements to support healthy bone mineral density levels. The supplements investigated included vitamin D(3), vitamin K(2), strontium, magnesium and docosahexaenoic acid (DHA), all chosen because of previous evidence about their benefit to bone health. Following a year-long study of patients with varying levels of bone loss, the Canadian researchers determined that this supplement regimen was as effective as a class of drugs often prescribed for osteoporosis (bisphosphonates, such as Fosamax or Boniva). And, they found that the combination of supplements was even effective for people who had failed to benefit from the prescription osteoporosis drugs.

We hope to see further study of supplement combinations for bone loss in people with HIV. It’s an acknowledged problem as HIVers get older, and if there’s a potential way to lower this health risk over the long run, let’s take a serious look at it!

Note: NYBC stocks Jarrow’s Bone Up or Ultra Bone Up, plus Max DHA or EPA-DHA Balance, which provide most of the micronutrients in the Canadian study (missing is the Strontium, but NYBC hopes to have a recommendation for that in the near future).

Visit the NYBC website for more information:

http://www.newyorkbuyersclub.org/

References:

The Johns Hopkins study: Walker Harris V, Brown TT. Bone loss in the HIV-infected patient: evidence, clinical implications, and treatment strategies. J Infect Dis. 2012 Jun;205 Suppl 3:S391-8. doi: 10.1093/infdis/jis199.

The Canadian study: Genuis SJ, Bouchard TP. Combination of Micronutrients for Bone (COMB) Study: bone density after micronutrient intervention. J Environ Public Health. 2012;2012:354151. doi: 10.1155/2012/354151.

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Media Distortions, as usual…

The news says: Elderly ladies, stop the Ca+D. The title here, for example:
USPSTF Says No to Vitamin D, Calcium for Older Women

The panel said something a bit different–don’t waste your time if the DOSE IS TOO LOW. Will have to get the original article. But it seems to be a tiresome misrepresentation of the data. At least, for those who read the article, they do note first —

“400 IU of vitamin D3 combined with 1,000 mg of calcium carbonate has no effect” BUT then —

“daily intake of 600 IU for vitamin D and 1,200 mg of calcium for women ages 51 to 70 had a clearer net benefit in fracture prevention.

Last month, the USPSTF finding that vitamin D supplements reduce the risk of falls in community-dwelling older people who may be prone to falling.”

Acquiring enough calcium from a healthy diet, getting enough sun and resistance exercise are all the BASIC elements of sustaining good bone health. Supplements have their place for many people. But the media distortions do not help people to make the best decision, especially when they outright distort the recommendation. And indeed many, many people are very low in Vitamin D–as we have discussed frequently here!

 

High Frequency of Vitamin D Deficiency in People with HIV

A number of reports in recent years have suggested an increased prevalence of osteopenia and osteoporosis (moderate and severe bone loss) in HIV-infected patients. In 2008, moreover, a study in the Journal of Clinical Endocrinology & Metabolism reported a higher rate of fractures in HIV-infected individuals compared with uninfected individuals. So there is reason for concern that osteoporosis and osteoporotic fractures will become major health problems for people with HIV as they age.

Here, we’re reporting on another study, released at the start of 2009, which fills in more pieces of information about bone health in people with HIV–and also provides guidance on supplementation strategies that could counteract bone loss and increased bone fracture rates associated with HIV. This research looked at fairly healthy (“ambulatory”) people with HIV visiting a Boston clinic in mid-winter and early spring months, and found a high frequency of vitamin D deficiency. Further tests linked this deficiency to a diminished ability to absorb and use calcium, the central ingredient in bone mass.

Based on their study, the investigators suggested that many people with HIV could benefit from daily vitamin D intake of at least 700-800 IU taken with 1200-1500mg of calcium, especially during the winter months, when the body does not have the opportunity to produce Vitamin D from exposure to sunlight.

Our conclusion: studies are now filling in the details that allow us to conclude that osteoporosis and osteoporosis-related fractures may become an increasingly important health concern for people with HIV as they age. However, there is also growing evidence that supplementing with Vitamin D and calcium can reduce this risk to bone health. It’s therefore important for people with HIV to check their multivitamin to see if they are getting appropriate levels of these two nutrients, or add a specific Vitamin D – Calcium supplement to their diet.

NOTE: NYBC stocks Vitamin D3 (the form most readily used by the body) and Calcium Blend (a food-based vegetarian supplement which includes Vitamin D3). Also available: Bone Up (Jarrow), a supplement containing calcium, Vitamin D and other components specifically for bone health.

Reference: M. Rodriguez, B. Daniels, S. Gunawardene, and G.K. Robbins. High Frequency of Vitamin D Deficiency in Ambulatory HIV-Positive Patients. AIDS RESEARCH AND HUMAN RETROVIRUSES, Vol 25, 1, 2009.