Epidemiology, Diagnosis, and Management of Bone Disease in Patients with Chronic HBV Infection
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Purpose of Review
Chronic hepatitis B (CHB) and treatment may be associated with increased risk of osteopenia/osteoporosis. Here, we review the prevalence of osteopenia/osteoporosis among patients with CHB and the effect of antiviral therapy on bone density. We also highlight screening and management strategies for bone disease among patients with CHB.
While there are concerns with first-line antiviral therapy such as tenofovir disoproxil fumarate in the development of osteopenia/osteoporosis, the available data remain rather unclear. However, with the development of tenofovir alafenamide, these concerns may be mitigated. At present, EASL recommends dual-energy X-ray absorption (DEXA) scans for patients with osteoporotic risk factors, with a repeat DEXA scan based upon baseline findings.
Patients with CHB have higher incidence and prevalence of osteopenia/osteoporosis compared with patients without CHB. Further studies are needed to understand the impact of antiviral therapy on bone therapy, and more CHB specific recommendations are needed for bone health management.
KeywordsHepatitis B Tenofovir disoproxil fumarate Entecavir Osteoporosis Tenofovir alafenamide
Compliance with Ethical Standards
Conflict of Interest
Mike T. Wei declares no potential conflict of interest. Mindie H. Nguyen received research support from Pfizer, Gilead Sciences, Janssen, Exact Sciences, Bristol-Myers Squibb, and Laboratory of Advanced Medicine and served as an advisory board member for Bristol-Myers Squibb, Gilead Sciences, Roche, Janssen, Novartis, Intercept, Anylam, Spring Bank, Bayer, Exact Sciences, Laboratory of Advanced Medicine, Eisai, and Dynavax. Dr. Nguyen also reports grants from Bristol-Myers Squibb, Janssen Pharmaceuticals, Gilead Sciences, NCI, and B. K. Kee Foundation and reports honorarium from Bristol-Myers Squibb, Gilead Sciences, Intercept Pharmaceuticals, Roche Laboratories, Dynavax Laboratory, and Alnylam Pharmaceuticals. Ramsey Cheung reports grants from Gilead Science, outside the submitted work.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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