Bone Mineral Density and Renal Function in Chronic Hepatitis B Patients Receiving Nucleotide versus Nucleoside Analogs: A Pilot Prospective Study
Chalermrat Bunchorntavakul MD*,**, Vitoon Taweewattanakitbavorn MD*, Amporn Atsawarungruangkit MD*,**
Affiliation : * Department of Medicine, Rajavithi Hospital, Ministry of Public Health, Bangkok, Thailand ** College of Medicine, Rangsit University, Bangkok, Thailand
Background : The use of nucleotide analogs (NTAs) can be associated with negative effects on renal function and bone mineral
density (BMD) due to proximal tubular dysfunction and hypophosphatemia; however, prospective data assessing the bone
and renal safety of these agents are limited.
Objective : This study aimed to evaluate the prevalence of bone diseases among chronic hepatitis B (CHB) patients without
cirrhosis and the changes in BMD and glomerular filtration rate (GFR) between patients receiving NTAs versus nucleoside
analogs (NSAs).
Material and Method: We prospectively collected data from non-cirrhotic CHB patients who had been treated for <1 year in
Rajavithi Hospital (Bangkok, Thailand) between 2012 and 2014. Patients with significant comorbidities or those being
treated for bone diseases were excluded. BMD assessment was performed at the lumbar spine (LS) and femoral neck (FN).
BMD T-scores were used to define osteopenia (-2.5 to -1) and osteoporosis (<-2.5), and the GFR was estimated using the
Cockcroft-Gault method.
Results : Twenty patients were included: 65% were men; 40% were HBeAg positive; and the median age was 42.7 (25.6-64.2)
years. Ten patients had been treated with NTAs (7 with tenofovir, 3 with adefovir) and 10 patients had been treated with NSAs
(8 with lamivudine, 2 with entecavir), with a median follow-up period of 1.5 years (1.2-1.6). At baseline, the overall
prevalence of osteopenia was 45% and the median GFR was 94 (51-144) mL/min. BMD in CHB patients was slightly lower
than in an age-matched population based on Z-scores. Changes in LS-BMD and FN-BMD were not significantly different
between groups. The annual reduction in GFR was more pronounced in the NTA group (-7.4% vs. -1.39%, p = 0.018).
Conclusion : Osteopenia is common in CHB patients without cirrhosis. Changes in BMD were not significantly different
between groups. The annual reduction in GFR was more pronounced in the NTA group.
Keywords : Bone mineral density, Renal function, Chronic hepatitis B, Nucleotide analog, Nucleoside analog, Osteopenia
