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. 2018 Mar;8(1):23-27.
doi: 10.1016/j.jceh.2017.05.009. Epub 2017 May 15.

Bone Health and Impact of Tenofovir Treatment in Men with Hepatitis-B Related Chronic Liver Disease

Kattiparambil G Sajith  1 , Nitin Kapoor  2 , Sahana Shetty  3 , Ashish Goel  1 , Uday Zachariah  1 , Chundamannil E Eapen  4 , Thomas V Paul  5
Affiliations

Bone Health and Impact of Tenofovir Treatment in Men with Hepatitis-B Related Chronic Liver Disease

Kattiparambil G Sajith et al. J Clin Exp Hepatol. 2018 Mar.

Abstract

Background: Chronic Liver Disease (CLD) has been shown to have an adverse impact on bone health. Hepatitis-B related CLD and its treatment with tenofovir may have additional effects on skeleton.

Objective: To study the impact of HBV related CLD and its treatment with Tenofovir on bone health in Indian subjects.

Methods: This cross sectional study included men (18-60 years) and comprised of three groups: Group-1 was treatment naïve HBV related CLD (n = 79), Group-2 those with HBV related CLD on tenofovir for at least 1 year (n = 136), Group-3 age, sex and Body Mass Index (BMI) matched healthy controls (n = 58). Bone biochemistry and Bone Mineral Density (BMD) at spine, Femoral Neck (FN) and forearm were studied. Independent t-test or ANOVA was used to compare the means of continuous variables and chi-square test for categorical variables. Multiple logistic regression was used to assess the factors causing Low Bone Mass (LBM) at FN.

Results: A significantly greater proportion (P < 0.05) of patients (40%) with CLD (group 1 and group 2) had vitamin D deficiency (<20 ng/ml) in comparison with control group (22%). The mean serum C-Terminal telopeptide was significantly higher (P < 0.05) and the mean BMD was significantly lower (P < 0.05) in subjects with HBV related CLD than controls. The prevalence of LBM was higher in group 1 at the spine (31%) and forearm (18.4%) when compared to controls (8.1% and 7.8% respectively) (P < 0.05). The proportion of patients with LBM at FN was highest in group 2 (12.3%) compared to those in group 1 (8%) and group 3 (4%) (P < 0.05). Advanced age, low BMI, and high viral load (>10,000 IU/ml) emerged as significant risk factors for LBM at FN.

Conclusion: The impact of hepatitis-B related CLD as well as its treatment on bone health is significant. Bone health need to be periodically evaluated in these subjects especially in older men who are lean and have a higher viral load.

Keywords: BMI, Body Mass Index; CLD, Chronic Liver Disease; FN, Femoral Neck; LBM, Low Bone Mass; bone mineral density; chronic liver disease; hepatitis-B; tenofovir.

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