Long-term TDF use ups fracture risk in older CHB patients

Use of tenofovir disoproxil fumarate (TDF) for ≥24 months increases the risk of fracture in older patients with chronic hepatitis B (CHB), reports a study.

The analysis included a total of 41,531 patients with CHB (mean age 69.8 years, 61.6 percent male) being treated with entecavir (n=39,897, 96.1 percent) and TDF (n=1,634, 3.9 percent). Of these, 1,733 (4.2 percent) developed incident fracture over a median follow-up of 25.3 months.

Patients who had incident fracture tended to have diabetes, hypertension, congestive heart failure, rheumatoid arthritis, osteoporosis, and a history of fracture.

The risk of incident fracture in TDF-treated patients, compared with propensity score-matched individuals treated with entecavir, was similar in the first 24 months (weighted subdistribution hazard ratio [sHR], 0.99, 95 percent confidence interval [CI], 0.56‒1.73; p=0.960) but escalated after that (weighted sHR, 1.80, 95 percent CI, 1.11‒2.93; p=0.019).

The corresponding 24-, 60-, and 96-month cumulative incidences of fracture in TDF- and entecavir-treated patients were as follows: 2.3 percent vs 2.6 percent; 6.4 percent vs 4.7 percent; and 10.2 percent vs 6.8 percent).

“Given the ageing population of patients with CHB and the rising prevalence of comorbidities, our findings support the current treatment guidelines that recommend selecting antiviral treatment based on age and comorbidities.,” the investigators said.

This study used a territory-wide database in Hong Kong to identify CHB patients, aged ≥60 years, treated with either TDF or entecavir between January 2008 and December 2022. After propensity score matching, the investigators compared the risk of incident fracture between TDF- and entecavir-treated patients before and after month 24.