Reduced bone mineral density and altered bone turnover markers in patients with non-cirrhotic chronic hepatitis B or C infection

Schiefke, Ingolf; Fach, Andreas; Wiedmann, Marcus; Aretin, Andreas von; Schenker, E; Borte, G.; Wiese, Manfred; Moessner, J.

doi:10.3748/wjg.v11.i12.1843

Cited by 138 publications

(110 citation statements)

References 32 publications

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“…Patients (especially males) with detectable HCV RNA expressed low BMD (at LS and hip), also in accordance with other studies [35,36]. No correlations were found between fibrosis grade and low BMD, a finding in accordance with some authors [30,37] but different from other studies [38]. Furthermore, we demonstrated that antiviral treatment, especially peginterferon alpha 2a and ribavirin, represents a risk factor for low BMD at all sites scans.…”

Section: Discussionsupporting

confidence: 75%

Body Composition Changes in Patients with Chronic Hepatitis C

Barbu

Chițu-Tișu

Lazăr

et al. 2016

JGLD

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Aims: We aimed to quantify global and regional body composition changes in chronic hepatitis C (CHC) patients, compare them to healthy controls and identify possible association between body composition changes and CHC. To our knowledge, this study is the first one comparing CHC patients to controls with regard to soft tissue body composition changes. Methods: We assessed 60 CHC patients and 60 healthy controls by Dual Energy X-Ray Absorptiometry. Soft tissue and bone body composition parameters were compared between the groups (using the Mann-Whitney test). These parameters were correlated (using Spearman’s rank correlation coefficient – rho) with independent variables (age, gender, body mass index – BMI, cigarette smoking, time since CHC diagnosis, viral load, fibrosis grade, type of treatment, time of treatment) for the entire CHC group and also for subgroups according to gender. Results: Total fat mass, trunk fat mass and percent body fat were lower in CHC patients as compared to controls. Several risk factors were associated with the reduced fat mass: low BMI, cigarette smoking and peginterferon alpha 2a plus ribavirin treatment. Peginterferon alpha 2a and ribavirin treatment negatively correlated with lean body parameters, especially in CHC males group. Bone mineral density (BMD) was lower as compared to controls and was correlated with low BMI, cigarette smoking and peginterferon alpha 2a and ribavirin treatment. Conclusions: Patients with CHC have an acquired type of lipodystrophy (particularly in the trunk region), and also a reduced BMD as compared with controls. A low BMI, cigarette smoking and peginterferon alpha 2a and ribavirin therapy were associatd with a low fat mass and low BMD. Abbreviations: BMD: bone mineral density; BMI: body mass index; CHC: chronic hepatitis C; DXA: Dual Energy X ray Absorptiometry; FM: fat mass; FMR: fat mass ratio; HCADS: hepatitis C associated dysmetabolic syndrome; HCV: hepatitis C virus; HO: hepatic osteodystrophy; LS: lumbar spine; LM: lean mass; PBF: percent body fat.

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Section: Discussionsupporting

confidence: 75%

Body Composition Changes in Patients with Chronic Hepatitis C

Barbu

Chițu-Tișu

Lazăr

et al. 2016

JGLD

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“…Hypogonadism, abnormalities of vitamin D metabolism, and increased bilirubin levels, situations usually found in chronic liver disease, may lead to either reduced bone formation or increased bone resorption [23][24][25]. The results from the studies that have investigated the impact of hepatitis C on osteoporosis of hemophilia patients are conflicting.…”

Section: Discussionmentioning

confidence: 76%

Increased bone resorption is implicated in the pathogenesis of bone loss in hemophiliacs: correlations with hemophilic arthropathy and HIV infection

et al. 2009

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International audienceOsteoporosis has been recently recognized as a severe comorbidity factor in hemophilia. However, its pathogenesis is still obscure. We evaluated the incidence of osteoporosis in 90 hemophilia patients and investigated possible correlations with clinical and laboratory data. Out of the 90 patients, 80 (89%) had severe hemophilia, and 35 (38.9%) were human immunodeficiency virus (HIV)-positive. Hemophilic arthropahty was assessed using World Federation of Hemophilia clinical score and Petterson radiological score. Bone mineral density of the lumbar spine (LS) and femoral neck (FN) were measured using dual-energy X-ray absortiometry. Bone turnover was evaluated by the measurement of: (1) bone resorption markers [N-terminal cross-linking telopeptide of collagen type I (NTX), C-terminal cross-linking telopeptide of collagen type I (CTX), and tartrate-resistant acid phosphatase isoform-5b (TRACP-5b)], (2) bone formation markers [bone-alkaline phosphatase (bALP) and osteocalcin], and (3) osteoclast stimulators (receptor activator of nuclear factor-κB ligand, osteoprotegerin, and tumor necrosis factor-alpha). Osteopenia or osteoporosis was observed in 86% and 65% of the patients in FN and LS, respectively. Osteoporosis was more common among HIV-positive patients in both FN (65.3% vs 41.6%; = 0.007) and LS (17.86% vs 5.41%, = 0.004). The severity of osteoporosis in FN correlated with the patients' total clinical and radiological score ( = 0.001). Hemophilia patients showed increased osteoclastic activity (significant increase of TRACP-5b, NTX, and CTX), which was not accompanied by a comparable increased bone formation (reduced osteocalcin and borderline increase of bALP). In multivariate analysis, HIV infection ( = 0.05) and total clinical score ( = 0.001) were independent risk factors for osteoporosis development. We conclude that there is a high prevalence of osteoporosis among hemophiliacs, which is related to the severity of arthropathy and is enhanced by HIV infection. We report for the first time a high bone resorption that seems not to be balanced by a comparable bone formation

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“…Osteoporosis is a frequent complication of end-stage liver disease irrespective of its etiology. The prevalence varies between 9% and 60%, the highest being observed in cholestatic disorders and alcoholic liver disease [23] . The present study aimed at elucidating the influence of bilharziasis, hepatitis B or C infections on the development of osteoporosis in children.…”

Section: Discussionmentioning

confidence: 99%