Assessment of Bone Mineral Density in Tenofovir-Treated Patients With Chronic Hepatitis B: Can the Fracture Risk Assessment Tool Identify Those at Greatest Risk?
Assessment of Bone Mineral Density in Tenofovir-Treated Patients With Chronic Hepatitis B: Can the Fracture Risk Assessment Tool Identify Those at Greatest Risk?
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DOI：
10.1093/infdis/jiu471
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发表时间：
2015-02-01
影响因子：
6.4
通讯作者：
Kennedy, Patrick T. F.
中科院分区：
文献类型：
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作者：
Gill, Upkar S.;Zissimopoulos, Alexandra;Kennedy, Patrick T. F.
背景富马酸替诺福韦酯（TDF）是一种治疗慢性B型肝炎的核苷酸类似物。骨密度损失已被描述在TDF治疗的人类免疫缺陷病毒感染的患者，但有限的数据存在慢性肝炎B患者。双能X线吸收法（DEXA）被用来确定骨密度的变化，在TDF暴露患者。我们评估了骨折风险评估工具（FRAX）作为DEXA替代品在临床实践中的准确性。共研究了170名患者：122名暴露于TDF，48名为对照组。所有患者均接受DEXA，并记录人口统计学详细信息。计算DEXA前后FRAX评分。TDF与较低的髋关节T评分相关（P = 0.02）。在单变量和多变量分析中，年龄增长、吸烟、低体重指数和TDF暴露是低骨密度的独立预测因素。此外，DEXA FRAX术前评分是DEXA FRAX术后治疗建议的准确预测因子（100%敏感性和83%特异性），曲线下面积为0.93（95%CI，0.87 - 0.97，P <0.001）。经TDP治疗的慢性B型肝炎患者骨密度降低，但仅限于1个解剖部位。年龄和晚期肝病是额外的影响因素，强调了多因素骨折风险评估的重要性。FRAX可以准确地识别那些最有可能发生骨质疏松性骨折的人。
Background. Tenofovir disoproxil fumarate (TDF) is an established nucleotide analogue in the treatment of chronic hepatitis B. Bone mineral density loss has been described in TDF-treated patients with human immunodeficiency virus infection, but limited data exist for patients with chronic hepatitis B. Dual X-ray absorptiometry (DEXA) was used to determine bone mineral density changes in TDF-exposed patients. We evaluated the accuracy of the Fracture Risk Assessment Tool (FRAX) as an alternative to DEXA in clinical practice.Methods. A total of 170 patients were studied: 122 were exposed to TDF, and 48 were controls. All patients underwent DEXA, and demographic details were recorded. FRAX scores (before and after DEXA) were calculated.Results. TDF was associated with a lower hip T score (P = .02). On univariate and multivariate analysis, advancing age, smoking, lower body mass index, and TDF exposure were independent predictors of low bone mineral density. In addition, the pre-DEXA FRAX score was an accurate predictor of the post-DEXA FRAX treatment recommendation (100% sensitivity and 83% specificity), area under the curve 0.93 (95% CI, .87-.97, P < .001).Conclusions. TDF-treated patients with chronic hepatitis B have reduced bone mineral density, but the reduction is limited to 1 anatomical site. Age and advanced liver disease are additional contributing factors, underlining the importance of multifactorial fracture risk assessment. FRAX can accurately identify those at greatest risk of osteoporotic fracture.