References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
People living with HIV are more likely to develop osteoporosis (thinning bones) and fractures than HIV-negative people of the same age. Research suggests bone mineral density is 6-15% lower on average, and fractures occur about 60% more often. Multiple factors contribute: HIV itself causes inflammation, some antiretroviral drugs affect bone metabolism, and traditional risk factors are more common in HIV populations.
The good news: bone loss can be slowed or reversed with the right approach. Here’s what you need to know.
Why Does HIV Affect Bone Health?
- Chronic inflammation: HIV causes persistent immune activation that affects bone cells
- Antiretroviral drugs: Tenofovir disoproxil (TDF) in particular reduces bone density. Newer tenofovir alafenamide (TAF) has less bone impact
- Vitamin D deficiency: More common in people with HIV
- Low testosterone: Occurs more frequently in HIV-positive men
- Traditional risk factors: Smoking, alcohol use, low body weight are often more prevalent
- Coinfections: Hepatitis C, which often coexists with HIV, affects bone health
How Bone Health Is Monitored
- DEXA scan: A bone density scan recommended for people with HIV who have risk factors (post-menopausal women, men over 50, prior fracture, long-term steroid use)
- Vitamin D levels: Checked routinely in HIV clinics
- FRAX calculator: Estimates 10-year fracture risk
How to Protect Your Bones
- Weight-bearing exercise: Walking, running, resistance training stimulates bone formation
- Calcium and vitamin D: Adequate dietary calcium (1000mg/day) and vitamin D supplementation if levels are low
- Stop smoking
- Limit alcohol
- Switch ART if needed: If tenofovir disoproxil is causing bone loss, your doctor may switch you to TAF or a different regimen
- Bisphosphonates: If osteoporosis is diagnosed, medications like alendronate can be prescribed
Read more: What is HIV? | Starting HIV treatment | ART side effects
Frequently Asked Questions
Does tenofovir cause bone loss?
Tenofovir disoproxil (TDF) is associated with a small reduction in bone mineral density. The newer tenofovir alafenamide (TAF) has much less bone impact. If you’re on TDF and have osteoporosis concerns, discuss switching with your HIV specialist.
Should I take vitamin D supplements?
Vitamin D deficiency is common in people with HIV. Have your levels checked. If low, supplementation (typically 800-2000 IU daily) is recommended.
Related reading
- A to Z of Sex: Sexual Health Terms Explained
- Alcohol and HIV: What You Need to Know
- Anxiety and HIV: Coping and Getting Support
- Are All STIs Curable?
- Blood Problems and HIV: Anaemia, Low Platelets and More
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
