Orsini Luciana G S, Pinheiro Marcelo M, Castro Charlles H M, Silva Antônio E B, Szejnfeld Vera L
Rheumatology Division, Universidade Federal de São Paulo/Escola Paulista de Medicina (Unifesp/EPM), São Paulo, Brazil.
PLoS One. 2013 Nov 28;8(11):e81652. doi: 10.1371/journal.pone.0081652. eCollection 2013.
The high prevalence of chronic hepatitis C (CHC) and its consequent cirrhosis has been associated with bone fragility. Whether CHC may cause bone and mineral abnormalities in the absence of hepatocellular dysfunction is still unknown. In this study we aimed to determine the prevalence of osteoporotic vertebral fractures and low BMD measurements in men with non-cirrhotic CHC. Risk factors for low BMD and fractures were also investigated.
Morphometric vertebral fractures and BMD measurements were performed in 60 non-cirrhotic untreated men with CHC and 59 healthy controls, matched for age and gender, weight and current smoking. Serum CTx, calcium, phosphate, intact PTH, alkaline phosphatase and vitamin D (25OHD) concentrations were measured in all participants. Clinical risk factors for low BMD and fractures were evaluated by a structured questionnaire as well as details regarding HCV infection.
Trochanter and total femur BMD were significantly lower in CHC patients as compared to healthy men (p = 0.04). In men 50 years and older, the prevalence of osteoporosis was significantly higher among CHC patients (p = 0.01). Lower levels of physical activities and more often report of prolonged immobilization were observed among CHC patients (p<0.05). Liver inflammation and fibrosis, viral load and genotype did not correlate with BMD measurements. Bone markers and 25OHD concentrations were similar in both groups. Only a few vertebral fractures were observed.
Our results demonstrate that non-cirrhotic untreated CHC patients have lower BMD at the femur as compared to healthy men in spite of the absence of significant bone and mineral abnormalities.
慢性丙型肝炎（CHC）的高患病率及其导致的肝硬化与骨脆性有关。在没有肝细胞功能障碍的情况下，CHC是否会导致骨与矿物质异常仍不清楚。在本研究中，我们旨在确定非肝硬化CHC男性患者骨质疏松性椎体骨折的患病率以及低骨密度测量情况。我们还研究了低骨密度和骨折的危险因素。
对60名未经治疗的非肝硬化CHC男性患者和59名年龄、性别、体重及当前吸烟情况相匹配的健康对照者进行椎体形态计量学骨折和骨密度测量。测量所有参与者的血清I型胶原交联C末端肽（CTx）、钙、磷、完整甲状旁腺激素（PTH）、碱性磷酸酶和维生素D（25OHD）浓度。通过结构化问卷评估低骨密度和骨折的临床危险因素以及有关丙型肝炎病毒（HCV）感染的详细情况。
与健康男性相比，CHC患者的粗隆和全股骨骨密度显著降低（p = 0.04）。在50岁及以上的男性中，CHC患者的骨质疏松患病率显著更高（p = 0.01）。CHC患者的身体活动水平较低，且更多人报告有长期制动情况（p<0.05）。肝脏炎症和纤维化、病毒载量及基因型与骨密度测量值无关。两组的骨标志物和25OHD浓度相似。仅观察到少数椎体骨折。
我们的结果表明，尽管没有明显的骨与矿物质异常，但未经治疗的非肝硬化CHC患者与健康男性相比，股骨骨密度较低。
