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A novel evidence of serial changes of bone mineral density in chronic hepatitis B patients treated with entecavir

Pao-Yuan Huang 1Sherry Yueh-Hsia Chiu 1 2Kuo-Chin Chang 1 3Po-Lin Tseng 1 3Yi-Hao Yen 1 3Ming-Chao Tsai 1 3Jing-Houng Wang 1 3Kwong-Ming Kee 1 3Chien-Hung Chen 1 3Chao-Hung Hung 1 3King-Wah Chiu 1 3Tsung-Hui Hu 4 5

Hepatol Int. 2021 Apr 27.

 doi: 10.1007/s12072-021-10148-z. .


Background and aims: Tenofovir disoproxil fumarate (TDF) and Entecavir (ETV) are commonly used for patients with chronic hepatitis B (CHB), and renal or bone toxicity are possible concerns. This study is to evaluate the renal and bone effect of TDF compared with ETV in CHB patients.

Methods: This is a retrospective study at Kaohsiung Chung-Gung memorial hospital, Taiwan, from June 2013 to December 2018. Patients with CHB were prescribed with TDF or ETV for 3 years or above. Renal function was assessed at 12-week intervals. Dual-energy X-ray absorptiometry scans of the spine and femurs were performed at 48-week intervals. The propensity score analysis was conducted to balance the baseline characteristics of patients in both treatment groups.

Results: A total of 258 patients were included in this study: TDF (n = 135) and ETV (n = 123). The prevalence of osteopenia was much higher in the TDF group at week 48 and week 96. The TDF group showed significant mean percentage decrease from baseline in bone mineral density throughout the treatment course. Logistic regression analysis adjusted for the propensity score demonstrated that the use of TDF was the only predictive factor of significant bone density loss at week 144. The mean percentage decline of estimated glomerular filtration rate was significant in the TDF group at all time points. Renal threshold phosphate concentration was similar among both treatment groups.

Conclusions: This study suggested CHB patients treated with TDF may experience increased risks of bone loss and renal deficits compared to those treated with ETV.