骨密度评估 在替诺治疗乙肝患者

StephenW

Assessment of Bone Mineral Density in Tenofovir-Treated Patients With Chronic Hepatitis B: Can the Fracture Risk Assessment Tool Identify Those at Greatest Risk?

    Upkar S. Gill1,
    Alexandra Zissimopoulos2,
    Safa Al-Shamma2,
    Katherine Burke2,
    Mark J. W. McPhail3,
    David A. Barr4,
    Yiannis N. Kallis2,
    Richard T. C. Marley2,
    Paul Kooner2,
    Graham R. Foster1 and
    Patrick T. F. Kennedy1

+ Author Affiliations

    1Hepatology Unit, Centre for Digestive Diseases, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London
    2Department of Hepatology, Barts Health NHS Trust
    3Department of Hepatology, Faculty of Medicine, Imperial College London, St Mary's Hospital, Paddington
    4Department of Infectious Diseases, Brownlee Centre for Infectious and Communicable Diseases, NHS Greater Glasgow and Clyde, United Kingdom

    Correspondence: Patrick T. F. Kennedy, MD, Blizard Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, 4 Newark St, London, UK, E1 2AT ([email protected]).

    Presented in part: British Society of Gastroenterology (BSG), Birmingham, United Kingdom, March 2011. PTH-085; European Association for the Study of Liver (EASL), Berlin, Germany, April 2011. S32; British Association for the Study of Liver (BASL), London, United Kingdom, September 2011. 61; American Association for the Study of Liver Disease (AASLD), San Francisco, November 2011. 1012; American Association for the Study of Liver Disease (AASLD), Boston, November 2012. 201; British Society of Gastroenterology (BSG), Glasgow, United Kingdom, March 2013. PWE-144.

Abstract

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.

StephenW

骨密度的替诺福韦治疗的患者评估慢性乙肝是：在骨折风险评估工具找出那些风险最大？

    Upkar S. Gill1，
    亚历山德拉Zissimopoulos2，
    萨法铝Shamma2，
    凯瑟琳Burke2，
    马克·J·W·McPhail3，
    大卫·Barr4，
    雅尼北Kallis2，
    理查德·T. C. Marley2，
    保罗Kooner2，
    格雷厄姆河Foster1和
    帕特里克T.F。Kennedy1

+作者所属机构

    1Hepatology单位，中心为消化系统疾病，暴雪的研究所，巴兹与医学的伦敦大学和牙科，伦敦大学玛丽皇后学院
    教研室肝脏病，Barts的健康国民保健信托基金
    肝病的3Department，医学院，英国伦敦帝国学院，圣玛丽医院，帕丁顿（Paddington）
    4Department传染病，布朗利中心和传染病，NHS的大格拉斯哥和克莱德，英国

    通讯地址：帕特里克·肯尼迪的TF，医学博士，暴雪的研究所，巴兹与医学和牙科的伦敦大学，伦敦大学玛丽皇后学院，4纽瓦克街，英国伦敦，E12AT（[email protected]）。

    介绍部分：消化内科（BSG），伯明翰，英国，2011年3月的英国社会PTH-085;欧洲协会的肝脏（EASL），德国柏林，2011年4月在S32的研究;肝（BASL），伦敦，英国，2011年9月61的英国研究协会;美国协会为肝病（AASLD），旧金山的研究，2011年11月1012;美国协会为肝病（AASLD），波士顿，2012年11月201的研究;消化科（BSG），格拉斯哥，英国，2013年3月PWE-144的英国社会。

摘要

背景。富马酸替诺福韦酯（TDF）是在慢性乙型肝炎骨密度损失的治疗中TDF治疗的患者与人类免疫缺陷病毒感染已经描述了一个既定的核苷酸类似物，但对于患有慢性乙型肝炎的双能X有限数据存在射线吸收法（DEXA）被用来确定在TDF暴露患者的骨矿物密度的变化。我们评估骨折风险评估工具（FRAX）的精度，在临床实践中的替代DEXA。

方法。总共有170名患者进行了研究：122暴露于TDF和48人的控制。所有患者均接受DEXA和人口统计资料记录。 FRAX分数（之前和之后DEXA）进行了计算。

结果。 TDF是与较低的臀T评分（P = 0.02）有关。单因素和多因素分析，年龄增长，吸烟，降低身体质量指数，以及TDF风险是低的骨密度的独立预测因素。此外，预DEXA FRAX评分的后DEXA FRAX治疗建议（100％的敏感性和83％特异性），面积曲线0.93（95％CI，0.87 - 0.97，P <下一个准确的预测。 001）。

结论。 TDF治疗的患者中慢性乙型肝炎具有降低的骨密度，但减少是有限的，以1解剖部位。年龄和先进的肝病额外的促成因素，强调多因素的骨折风险评估的重要性。 FRAX可以准确地识别那些处于骨质疏松性骨折的危险性最大。