Department of Gastroenterology, Health Science University, Ümraniye Training and Research Hospital, İstanbul, Turkey.
Turk J Gastroenterol. 2022 Jan;33(1):35-43. doi: 10.5152/tjg.2020.18024.
We aimed to investigate the long-term effects of tenofovir disoproxil fumarate and entecavir treatment on bone mineral density and evaluated the fracture risk assessment tool score in patients with chronic hepatitis B.
A total of 58 chronic hepatitis B patients treated with tenofovir disoproxil fumarate (n = 40) and entecavir (n = 18) were included in this prospective study from 2012 to 2016. To evaluate bone mineral density, dual-X-ray absorptiometry, fracture risk assessment tool, and laboratory examinations were performed in all patients first at baseline and second at the end of the study.
Age, sex, body mass index, fibrosis score, and viral load were similar in both groups. The mean follow-up was 33 months in the tenofovir disoproxil fumarate group and 31 months in the entecavir group. In patients treated with entecavir, there was no statistically significant difference between baseline and second bone mineral density including lumbar spine (L) and total hip T score. In patients treated with tenofovir disoproxil fumarate, there was a significant difference in the second bone mineral density compared with baseline bone mineral density for L3 (P = .033) and the major fracture risk assessment tool score (P = .03). When patients were divided into 3 groups (normal bone mineral density, osteopenic, and osteoporotic), there was a significant increase in the number of osteopenic patients in the total hip T score after tenofovir disoproxil fumarate treatment (P = .034).
Our results suggest a decrease in the bone mineral density for lumbar spine (L3), an increase in the number of patients with hip osteopenia, and major fracture risk assessment tool score after long-term tenofovir disoproxil fumarate treatment in patients with rechronic hepatitis B.
本研究旨在探讨替诺福韦酯和恩替卡韦治疗对慢性乙型肝炎患者骨密度的长期影响，并评估骨折风险评估工具评分。
本前瞻性研究纳入了 2012 年至 2016 年间使用替诺福韦酯（n = 40）和恩替卡韦（n = 18）治疗的 58 例慢性乙型肝炎患者。所有患者均行双能 X 线吸收法骨密度测定、骨折风险评估工具和实验室检查，首次在基线时，第二次在研究结束时。
两组患者的年龄、性别、体重指数、纤维化评分和病毒载量相似。替诺福韦酯组的平均随访时间为 33 个月，恩替卡韦组为 31 个月。在接受恩替卡韦治疗的患者中，腰椎（L）和全髋 T 评分的基线和第二次骨密度无统计学差异。在接受替诺福韦酯治疗的患者中，与基线骨密度相比，L3 的第二次骨密度有显著差异（P =.033），主要骨折风险评估工具评分也有显著差异（P =.03）。当患者被分为 3 组（正常骨密度、骨量减少和骨质疏松）时，接受替诺福韦酯治疗后全髋 T 评分的骨量减少患者数量显著增加（P =.034）。
本研究结果表明，长期使用替诺福韦酯治疗后，慢性乙型肝炎患者腰椎（L3）骨密度降低，髋部骨质疏松患者数量增加，主要骨折风险评估工具评分升高。
