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Published on: July 24, 2013
Hepatitis C virus coinfection as a risk factor for osteoporosis and fracture
Roger Bedimo1, Naim M Maalouf, Vincent Lo Re
1aInfectious Diseases Section, Medical Service, Veterans Affairs North Texas Healthcare System bDivision of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center cEndocrine Section, Medical Service, Veterans Affairs North Texas Healthcare System dDivision of Mineral Metabolism, Department of Internal Medicine, and the Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas eDivision of Infectious Diseases, Department of Medicine fDepartment of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Insights
Hepatitis C virus (HCV) coinfection significantly increases osteoporosis and fracture risk in HIV patients, even before cirrhosis. Further research is needed for optimal bone health management in these individuals.
Area of Science:
- Bone Metabolism and Infectious Diseases
- Hepatology and Virology
- Infectious Disease Epidemiology
Background:
- Increased survival in HIV patients has led to osteoporotic fractures becoming a major morbidity.
- Chronic hepatitis C virus (HCV) coinfection is a significant contributor to increased fracture risk in HIV-infected individuals.
Purpose of the Study:
- To review epidemiologic and clinical evidence for osteoporosis and fracture risk in HIV/HCV coinfected patients.
- To explore potential mechanisms linking HCV coinfection to skeletal fragility.
Main Methods:
- Review of epidemiologic and clinical studies on HIV/HCV coinfection and bone health.
- Analysis of factors contributing to reduced bone mineral density (BMD) and fracture risk.
- Discussion of emerging tools for assessing bone quality.
Main Results:
- HIV/HCV coinfected patients have a three-fold increased fracture incidence versus controls.
- Chronic HCV coinfection is independently linked to reduced BMD in HIV patients, irrespective of liver disease stage.
- New tools like trabecular bone score and HR-pQCT may enhance understanding of skeletal fragility.
Conclusions:
- Chronic HCV infection is an independent risk factor for osteoporosis and fractures in HIV patients, even pre-cirrhosis.
- Mechanisms underlying HCV-associated bone fragility are under investigation.
- Optimal evaluation and management strategies for bone health in HIV/HCV coinfected patients require further study.
Purpose Of Review:
With increased survival of HIV-infected patients, osteoporotic fractures have developed as a major cause of morbidity in these patients, and chronic hepatitis C virus (HCV) coinfection has emerged as a significant contributor to this increased fracture risk. The present article reviews the epidemiologic and clinical evidence for osteoporosis and increased fracture risk among HIV/HCV coinfected patients, and potential mechanisms for these outcomes with HCV coinfection.
Recent Findings:
Epidemiologic studies suggest that HIV/HCV coinfected patients exhibit a three-fold increased fracture incidence compared with uninfected controls, and 1.2-2.4-fold increased fracture risk compared with HIV monoinfected patients. Recent reports suggest that chronic HCV coinfection is independently associated with reduced bone mineral density in HIV, but that it is not associated with significantly increased bone turnover. The deleterious impact of chronic HCV on BMD and fracture risk occurs even in the absence of advanced liver fibrosis or cirrhosis. New tools to assess bone quality, including the trabecular bone score, high-resolution peripheral quantitative computed tomography, and in-vivo microindentation, may help improve understanding of the mechanisms of HCV-associated skeletal fragility. The impact of approved antiosteoporosis medications and direct-acting antivirals for the treatment of chronic HCV infection on patients' bone health remain to be studied.
Summary:
Chronic HCV infection is an independent risk factor for osteoporosis and fractures among HIV-infected patients, even before the development of cirrhosis. The underlying mechanisms are being unraveled, but major questions persist regarding the optimal evaluation and management of bone health in HIV/HCV coinfected patients.
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