Tonon Marta, Piano Salvatore, Romano Antonietta, Fasolato Silvano, Stanco Marialuisa, Pilutti Chiara, Pontisso Patrizia, Mareso Sara, Gambino Carmine, Sartori Leonardo, Angeli Paolo
Unit of Internal Medicine 5 and Hepatology (UIMH), Department of Medicine (DIMED).
Unit of Internal Medicine 1, Department of Medicine (DIMED), University of Padova, Padova, Italy.
Eur J Gastroenterol Hepatol. 2018 Mar;30(3):284-290. doi: 10.1097/MEG.0000000000001051.
Tenofovir and entecavir are nowadays the first-line treatment in hepatitis B virus (HBV)-related cirrhosis. Both drugs were shown to be effective in HBV suppression and well tolerated. The effects of tenofovir on bone mineral density (BMD), however, were shown to worsen the rate of osteoporosis, which is already a common feature in cirrhosis. In contrast, entecavir seems to have no effect on mineral metabolism. The aim of our study was to compare the effects of nucleos(t)ide analogs on bone density in HBV-related cirrhosis.
Fourty-eight patients were treated with tenofovir and 22 patients were treated with entecavir, and were followed prospectively from 2008 to 2013. To evaluate BMD, laboratory examinations, dual-X-ray absorptiometry, and Fracture Risk Assessment Tool were assessed.
During the study, no difference was found between the two groups in the plasmatic concentration of calcium, phosphate, vitamin D, parathyroid hormone, or creatinine. Dual-X-ray absorptiometry showed no difference in the T-score and Fracture Risk Assessment Tool showed no significant difference in the 10-year risk of osteoporotic fractures in the two groups. On univariate and multivariate analyses, the only predictors of osteoporosis development were the prognostic scores of liver disease and BMI.
Both tenofovir and entecavir are effective in treating HBV in cirrhotic patients. The known effects of tenofovir on BMD do not worsen osteoporotic fractures risk compared with entecavir in these patients.
替诺福韦和恩替卡韦如今是乙型肝炎病毒（HBV）相关肝硬化的一线治疗药物。这两种药物均显示出在抑制HBV方面有效且耐受性良好。然而，替诺福韦对骨矿物质密度（BMD）的影响显示会加剧骨质疏松症的发生率，而骨质疏松症在肝硬化中已是常见特征。相比之下，恩替卡韦似乎对矿物质代谢没有影响。我们研究的目的是比较核苷（酸）类似物对HBV相关肝硬化患者骨密度的影响。
48例患者接受替诺福韦治疗，22例患者接受恩替卡韦治疗，并于2008年至2013年进行前瞻性随访。为评估BMD，对实验室检查、双能X线吸收法及骨折风险评估工具进行了评估。
在研究期间，两组在血浆钙、磷、维生素D、甲状旁腺激素或肌酐浓度方面未发现差异。双能X线吸收法显示两组的T值无差异，骨折风险评估工具显示两组在骨质疏松性骨折的10年风险方面无显著差异。在单因素和多因素分析中，骨质疏松症发生的唯一预测因素是肝病预后评分和体重指数。
替诺福韦和恩替卡韦在治疗肝硬化患者的HBV方面均有效。与恩替卡韦相比，替诺福韦对BMD的已知影响并未增加这些患者骨质疏松性骨折的风险。
