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Hepatitis C-Associated Osteosclerosis: Improvement After Treatment with Sofosbuvir, Daclatasvir, and Ibandronate: Case Report and Literature Review

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Abstract

Hepatitis C-associated osteosclerosis (HCAO) remains a rare condition despite the growing prevalence of hepatitis C virus (HCV) infection worldwide. Since the first case reported in 1992, this is the twenty-second case described. Patients with HCAO present with severe bone pain and elevated serum levels of bone markers, especially alkaline phosphatase (ALP), with increased bone density. We report here the case of a 59-year-old man with generalized bone pain and diagnosis of HCV infection. Biochemical tests showed elevated bone turnover markers, specifically, ALP, carboxy-terminal collagen crosslinks and osteocalcin. Imaging studies revealed generalized bone sclerosis. Bone mineral density was elevated in all validated sites. His clinical symptoms and bone-related findings were attributed to HCAO. He was sequentially treated with cholecalciferol, prednisone, sofosbuvir associated with daclatasvir and ibandronate, and progressed with undetectable viral load after HCV treatment, normalization of ALP levels after introduction of ibandronate, and pain improvement 1 year after discontinuation of the bisphosphonate. Bone pain complaints must be investigated in patients with HCV. HCAO is a differential diagnosis of increased bone mass.

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Funding

No funding was received to assist with the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Endocrinology, Hospital do Servidor Público Municipal (HSPM), São Paulo, SP, Brazil

    Maria Carolina de Camargo Vieira, Wagner Rodrigo Brida Gonçalves & Ricardo Ayello Guerra

  2. Department of Medicine, Endocrinology Unit, Federal University of São Paulo (UNIFESP), Rua Estado de Israel, 639, Vila Clementino, São Paulo, SP, CEP 04022-001, Brazil

    Maria Carolina de Camargo Vieira, Marise Lazaretti-Castro & Sergio Setsuo Maeda

  3. Department of Endocrinology, Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo (IAMSPE), São Paulo, SP, Brazil

    Ricardo Ayello Guerra

  4. Instituto de Infectologia Emílio Ribas (IIER), São Paulo, SP, Brazil

    Fabiana Siroma Callegaro

Authors
  1. Maria Carolina de Camargo Vieira
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  2. Wagner Rodrigo Brida Gonçalves
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  3. Ricardo Ayello Guerra
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  5. Marise Lazaretti-Castro
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  6. Sergio Setsuo Maeda
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Contributions

MCCV, WRBG and FSC performed the procedure and designed the study; MCCV wrote the draft; MCCV, SSM and MLC performed the literature review; MCCV, SSM and MLC and RAG reviewed the draft; all authors read and approved the final manuscript.

Corresponding author

Correspondence to Maria Carolina de Camargo Vieira.

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Conflict of interest

Maria Carolina de Camargo Vieira, Wagner Rodrigo Brida Gonçalves, Ricardo Ayello Guerra, Fabiana Siroma Callegaro, Marise Lazaretti-Castro, Sergio Setsuo Maeda have no conflicts of interest to declare that are relevant to the content of this article.

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This study was approved by the Research Ethics Committee of the Federal University of São Paulo (UNIFESP).

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Informed consent was obtained from the participant included in the study.

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de Camargo Vieira, M.C., Gonçalves, W.R.B., Guerra, R.A. et al. Hepatitis C-Associated Osteosclerosis: Improvement After Treatment with Sofosbuvir, Daclatasvir, and Ibandronate: Case Report and Literature Review. Calcif Tissue Int 109, 104–109 (2021). https://doi.org/10.1007/s00223-021-00822-7

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  • DOI: https://doi.org/10.1007/s00223-021-00822-7

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