Hepatitis C virus coinfection as a risk factor for osteoporosis and fracture

Abstract

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) co-infection has emerged as a significant contributor to this increased fracture risk. This article reviews the epidemiologic and clinical evidence for osteoporosis and increased fracture risk among HIV/HCV co-infected patients, as well as potential mechanisms for these outcomes with HCV co-infection. Recent Findings Epidemiologic studies suggest that HIV/HCV co-infected patients exhibit a 3-fold increased fracture incidence compared to uninfected controls, and 1.2–2.4-fold increased fracture risk compared to HIV mono-infected patients. Recent reports suggest that chronic HCV co-infection 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 anti-osteoporosis 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 prior to 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 co-infected patients.

Poor 1st-year adherence to anti-osteoporotic therapy increases the risk of mortality in patients with magnetic resonance imaging-proven acute osteoporotic vertebral fractures

“…In Taiwan, there is a high prevalence of hepatitis B and C 29–31. In previous studies, hepatitis has been shown to increase the risk of osteoporosis in Taiwan 32–34. Thus, patients with hepatitis may be more likely to visit an osteoporosis clinic for low bone mass-related fractures, further strengthening the consideration that hepatitis is an associated medical illness, as noted in this study.…”

Understanding mechanisms to promote successful aging in persons living with HIV

“…Substance abuse, including alcohol and intravenous drug use, is also highly prevalent in PLWH and has been linked to CVD, geriatric syndromes, and increased all-cause mortality (Chander et al, 2006). Co-infections with HBV and HCV, as mentioned previously, lead to a higher burden of hepatocellular carcinoma, and HCV infection is also an independent risk factor for osteopenia and osteoporosis (Bedimo et al, 2016). Other traditional risk factors for the development of chronic diseases, including hypertension, diabetes, dyslipidemia, and obesity, are all seen at increased rates in PLWH.…”

Osteoporosis Complicating Some Inborn or Acquired Diseases

“…Suboptimal serum vitamin D is frequently observed in HIV/AIDS patients treated with anti-retroviral pharmaceuticals (Mastaglia et al 2017). Epidemiologic studies suggested a three-fold increased fracture incidence in patients coinfected with HIV/hepatitis C virus even before development of cirrhosis (Bedimo et al 2016, Weitzmann et al 2016) (see below).…”

“…Complication of cirrhosis with osteoporosis is very common (50 %), in chronic active hepatitis 9.1 % (Bedimo et al 2016). Fractures are often two fold in patients with chronic liver disease (Handzlik-Orlik et al (2016).…”