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Epidemiology, Diagnosis, and Management of Bone Disease in Patients with Chronic HBV Infection

  • Hepatitis B (JK Lim, Section Editor)
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Abstract

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.

Recent Findings

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.

Summary

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.

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Authors and Affiliations

  1. Department of Medicine, Stanford University, Palo Alto, CA, USA

    Mike T. Wei

  2. Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, CA, USA

    Mike T. Wei, Mindie H. Nguyen & Ramsey Cheung

  3. Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, GI-111, Palo Alto, CA, 94304, USA

    Ramsey Cheung

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Correspondence to Ramsey Cheung.

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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.

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Wei, M.T., Nguyen, M.H. & Cheung, R. Epidemiology, Diagnosis, and Management of Bone Disease in Patients with Chronic HBV Infection. Curr Hepatology Rep 18, 322–330 (2019). https://doi.org/10.1007/s11901-019-00481-1

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