HIV Nutrition Update - Issue 53 Bone Disorders


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	HIV NUTRITION UPDATE


	VOLUME 9, ISSUE 5

Bone Disorders

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^{Preventive Measures}

^{Physical activity
by adults declines with age, with women being consistently less active
than men. (5) Christine M. Snow, PhD notes that load-bearing exercise during
youth and early adulthood appears to provide lasting benefits. (2) Both
impact and resistance exercises increase bone mass and alter bone geometry
in children before adolescence. Adults can benefit from exercise as well
and studies show that they lose 1- 3% of bone mass within three to six
months of ending an exercise regimen. Physical activity in adults over
the age of 50 is also beneficial and at least 30 minutes of daily moderate
physical activity, including weight-bearing exercises, strength and balance
training will increase bone density and muscle strength. A key challenge
to promoting bone health includes educating and promoting awareness of
the issues among policymakers, health care and other professionals, and
the general public. (5)}

^{In 2002, Anna Tosteson,
ScD from the Center for the Evaluative Clinical Sciences at Dartmouth Medical
School noted the government pays for most of the health care costs of osteoporosis
in women over the age of 45, with Medicare paying nearly half (48%) and
Medicaid covering nearly a quarter (24%) of the expenses. (2) Office-based
dual energy x-ray absorptiometry (DEXA) was said to cost roughly $125.
A complex set of codes that are used inconsistently act as one of the barriers
to payment for bone density testing. At the time of the 2002 workshop,
controversial issues in diagnosis included how to apply t-score categories
to men and non-Caucasian women. Nelson Watts, MD of the Osteoporosis Center,
University of Cincinnati reported that bone diseases can exist for years
before any obvious signs such as a fracture occur. Osteo-research
products for measuring human bone resorption are available.}

References

1. National Institutes of Health Consensus Development Conference Statement. Osteoporosis Prevention, Diagnosis, and Therapy. March 27-29, 2000. Accessed 7 May 2002.

2. Moritsugu KP, Slater E, McGowan JA, et al. Report of the Surgeon General's Workshop on Osteoporosis and Bone Health; 2002 Dec 12-13;Washington, DC [report on the Internet]: U.S. Department of Health and Human Services (HHS); c2003.

3. By 2020, One In Two Americans Over Age 50 Will Be At Risk For Fractures From Osteoporosis Or Low Bone Mass. HHS Press Release 2004 October 14.

4. Americans Over 50 at Risk for Bone Fractures. FDA Consumer, Jan-Feb 2005;39(1):10-11.

5. Carmona RH. U.S. Dept. of HHS. Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville, MD: U.S. Dept. of HHS, Office of the Surgeon General, revised: 12 Oct 2004.

6. National Osteoporosis Foundation: Osteoporosis: What is it? Washington, DC: National Osteoporosis Foundation.

7. Tebas P, Powderly WG, Claxton S, et al. Accelerated Bone Mineral Loss In HIV-infected Patients Receiving Potent Antiretroviral Therapy. AIDS 2000;14(4):F63-7.

8. Borderi M, Farneti B, Tampellini L, et al. HIV-1, HAART And Bone Metabolism. New Microbiol 2002;25(3):375-84.

9. Ries MD, Barcohana B, Davidson A, et al. Association Between Human Immunodeficiency Virus and Osteonecrosis of the Femoral Head. J Arthroplasty 2002;17(2):135-139.

10. Thomas J, Doherty SM. HIV infection: A Risk Factor For Osteoporosis. J Acquir Immune Defic Syndr 2003;33(3):281-91.

11. Brown TT, Ruppe MD, Kassner R, et al. Reduced Bone Mineral Density In Human Immunodeficiency Virus-Infected Patients And Its Association With Increased Central Adiposity And Postload Hyperglycemia. J Clin Endocrinol Metab 2004;89(3):1200-6.

12. Miller KD, Masur H, Jones EC, et al. High Prevalence Of Osteonecrosis Of The Femoral Head In HIV-Infected Adults. Annals Internal Med 2002;137(1):17-25.

13. Madeddu G, Spanu A, Solinas P, et al. Bone Mass Loss And Vitamin D Metabolism Impairment In HIV Patients Receiving Highly Active Antiretroviral Therapy. Q J Nucl Med Mol Imaging 2004;48(1):39-48.

14. Qaqish RB, Sims KA. Bone Disorders Associated With The Human Immunodeficiency Virus: Pathogenesis And Management. Pharmacotherapy 2004;24(10):1331-46.

15. Miller MG, Mulligan T. Human Immunodeficiency Virus And Hypogonadal Bone Disease. Pharmacotherapy 2005;25(4):632-4; discussion 634.

16. Heap J, Murray MA, et al. Alterations In Bone Characteristics Associated With Glycemic Control In Adolescents With Type 1 Diabetes Mellitus. J Pediatr 2004;144(1):56-62.

17. Piepkorn B, Kann P, Forst T, et al. Bone Mineral Density And Bone Metabolism In Diabetes Mellitus. Horm Metab Res 1997;29(11):584-91.

18. Wang J, Zhou J, Cheng CM, et al. Evidence Supporting Dual, IGF-I-Independent And IGF-I-Dependent, Roles For GH In Promoting Longitudinal Bone Growth. J Endocrinol 2004;180(2):247-55.

19. O'Conner DJ. Building Better Bones. Thorne Research, Inc., 1997. Accessed 7 May 2000.

20. Tinnerello D. Bone Health and Osteoporosis. Accessed 7 May 2000.

21. Holick MF. Vitamin D: importance In The Prevention Of Cancers, Type 1 Diabetes, Heart Disease, And Osteoporosis. Am J Clin Nutr 2004;79(3):362-71.

22. Nutrition News Focus Electronic Listserv message. Accessed 26 July 2005.

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8/15/2005