Chronic hepatitis B impairs bone health regardless of medication

By itself, chronic hepatitis B infection compromises bone health by increasing bone resorption, regardless of the use of antiretroviral drugs, a recent study has found.

The researchers cross-sectionally examined 81 adult patients with chronic hepatitis B infection. Dual-energy X-ray absorptiometry was used to measure bone mineral density, while biochemical analyses were also performed to quantify levels of markers such as osteocalcin, parathyroid hormone, and urinary deoxypyridinoline, among others.

The participants were divided into three groups of 27, each according to treatment approach. Group 1 included inactive virus carriers without medication, group 2 had patients treated with tenofovir, while those on lamivudine/entecavir medication fell under group 3. All three groups were generally comparable, except for viral load, which was significantly elevated in group 1 vs 2 and 3 (p=0.001).

According to DXA, osteopoenia at the lumbar spine occurred more frequently in the tenofovir group as opposed to groups 1 and 3 (14.8 percent vs 7.4 percent and 7.4 percent, respectively). Nevertheless, bone mineral density Z scores at the lumbar spine did not differ across the three groups (p=0.068). The same was true for Z scores at the total hip (p=0.210) and femoral neck (p=0.231).

In terms of serum and urinary markers, levels of osteocalcin and parathyroid hormone were significantly different across groups (p=0.025 and p=0.011, respectively), with a tendency to be higher in group 2. However, all values remained within the normal limits.

Notably, while concentrations of urinary deoxypyridinoline, a marker for bone resorption, did not differ among groups (p=0.295), all levels were above the normal limit, suggesting elevated resorptive activity in patient with chronic hepatitis B.

“Studies about bone metabolism and how it can be affected by factors such as chronic infections and medications continue to evolve and pose a major challenge to better understand the physiology of bone loss,” the researchers said, adding that more research is needed to validate the present findings.