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BONE LOSS in HCV
Reported by Jules Levin
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A percentage of person with HIV are suffering bone loss, osteopenia &
posteporosis. Much research on this has been conducted and can be found on
the NATAP website. Persons with HCV also have bone loss. And several
comprehensive articles on this can be found by using the NATAP website search
engine or trying the Lipodystrophy section on the site. At DDW researchers
from the Mayo Clinic presented an oral talk about the prevalence of bone loss
in HCV. Below is a description of their study. HCV therapy that cleared HCV
viral load may reverse the bone loss issue because the problem may be due to
the presence of virus. Persons coinfected with HIV and HCV face a potential
double hit on bone loss. It is particularly important to consider improving
diet, calcium supplementation, weight bearing exercise, and reducing
cofactors that may increase risk for bone loss. The articles on the NATAP
website discuss extensively all the potential cofactors which include smoking
cigarettes, coritcosteroids (from PCP prophylaxis) and a number of others.
This study looked at 207 patients transplanted at the Mayo Clinic. Follow-up
was for as long as 12 months. There were 68 patients with HCV; they were on
average 54 years of age, 49% male. 11% were using calcium and 5% Vitamin D. A
percentage of them were smokers. Before transplant 37% had osteopenia and 28%
osteoporosis. After 12 months follow-up about the same percentage had
osteoporosis. The fracture rate was 8.8% before transplant and 16% 12 months
after transplant. 80% of the fractures were spinal. The authors concluded 66%
of patients with End Stage Liver Disease related to HCV have osteopenic bone
disease prior to liver transplant.
OSTEOPENIA AND FRACTURING IN HEPATITIS C AND ALCOHOLIC LIVER DISEASE (ALD):
NOT JUST A CHOLESTATIC PROBLEM
Elizabeth Carey, Vijayan Balan, Walter K. Kremers, J E. Hay, Phoenix, AZ;
Rochester, MN
BACKGROUND: The increased prevalence of osteoporosis in patients with
cholestatic liver diseases is well established. The prevalence of metabolic
bone disease in end stage liver disease (ESLD) due to viral etiologies is not
well known. In a recent small study, we found that patients with ESLD due to
hepatitis C (HCV) in combination with alcohol had higher rates of
osteoporosis (T-score<-2.5) (53%) than patients with ESLD related to HCV
alone (23%) or alcoholic liver disease alone (37%) (Yousfi, Hepatology
2001;34:A232).
AIMS: 1) To compare the prevalence of osteopenia in patients with ESLD
secondary to HCV, Alcoholic liver disease (ALD), and HCV+ALD, 2) to determine
the effect of orthotopic liver transplantation (OLT) on bone density in these
groups, and 3) to determine fracture rates before and after OLT.
METHODS: From 1991 to present, all patients transplanted at Mayo Rochester
for HCV, ALD, or HCV+ALD were followed pretransplant, at 4 months and 12
months after OLT. All patients were followed clinically, biochemically,
radiologically and by measurements of Bone Mineral Density (BMD).
RESULTS: Pretransplant demographics and T scores of lumbar spine before and
after OLT are summarized in the table below. Baseline mean T-score was lower
in the HCV group than in the ALD group (p=0.048). All groups showed a T-score
nadir at 4mo post-OLT with mild improvement at 12mo post-OLT. The ALD group
sustained the highest fracture rate (ALD: 19.7%, HCV: 14.7%, HCV+ALD: 16.4%).
Most (88%) were vertebral compression fractures.
CONCLUSIONS: Patients with advanced HCV have lower BMD than those with ALD or
HCV+ALD, despite more advanced liver disease in the ALD group. Fractures were
not uncommon in the first post-operative year in patients transplanted for
HCV and ALD. As with cholestatic liver disease, osteopenia and fractures must
be considered in the management of patients with advanced hepatitis C and
advanced alcoholic liver disease especially in the setting of liver
transplantation.
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