Impact of chronic hepatitis B virus infection on bone mineral density

Abstract

Background: Chronic hepatitis B virus (HBV) infection is a common health problem that has a worldwide distribution. Apart from the direct effect of the virus on the liver, there are many extrahepatic manifestations among which the probable effect on bone turnover associated with low bone mineral density (BMD). Objectives: This study aimed to determine the association between treated and untreated chronic HBV infection with BMD. Methods: This is a cross-sectional study which included a total of 48 patients with chronic HBV (28 patients treated with tenofovir-disoproxil-fumarate [TDF] antiviral drug and 20 patients have not yet started treatment). Other age- and sex-matched 30 apparently healthy individuals were recruited to represent the healthy controls. BMD was measured using dual-energy X-ray absorptiometry on the anteroposterior lumbar spine (L1–L4 spine) views, from which T-score was calculated. Liver function tests were also evaluated from serum samples. Results: Treated patients showed a lower T-score (−0.48 ± 0.72) than either healthy individuals (1.08 ± 0.84) or untreated patients (0.78 ± 0.51), with highly significant differences. In multivariate regression, only disease duration (adjusted odds ratio [OR] = 9.71, 95% confidence interval [CI] = 4.8–16.68) and TDF treatment (adjusted OR = 6.4, 95% CI = 4.18–97.05) were significantly associated with BMD. Conclusions: Prolonged use of TDF in the treatment of HBV infection can significantly reduce BMD. Moreover, BMD can also be inversely affected in long-standing HBV, regardless of treatment regimen.