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Assessment of bone mineral density in patients with cirrhosis treated with third-generation nucleos(t)ide analogues

comparison between tenofovir and entecavir

Tonon, Martaa; Piano, Salvatorea; Romano, Antoniettaa; Fasolato, Silvanoa; Stanco, Marialuisaa; Pilutti, Chiaraa; Pontisso, Patriziaa; Mareso, Saraa; Gambino, Carminea; Sartori, Leonardob; Angeli, Paoloa

European Journal of Gastroenterology & Hepatology: March 2018 - Volume 30 - Issue 3 - p 284–290
doi: 10.1097/MEG.0000000000001051
Original Articles: Hepatitis B

Background and aim Tenofovir and entecavir are nowadays the first-line treatment in hepatitis B virus (HBV)-related cirrhosis. Both drugs were shown to be effective in HBV suppression and well tolerated. The effects of tenofovir on bone mineral density (BMD), however, were shown to worsen the rate of osteoporosis, which is already a common feature in cirrhosis. In contrast, entecavir seems to have no effect on mineral metabolism. The aim of our study was to compare the effects of nucleos(t)ide analogs on bone density in HBV-related cirrhosis.

Patients and methods Fourty-eight patients were treated with tenofovir and 22 patients were treated with entecavir, and were followed prospectively from 2008 to 2013. To evaluate BMD, laboratory examinations, dual-X-ray absorptiometry, and Fracture Risk Assessment Tool were assessed.

Results During the study, no difference was found between the two groups in the plasmatic concentration of calcium, phosphate, vitamin D, parathyroid hormone, or creatinine. Dual-X-ray absorptiometry showed no difference in the T-score and Fracture Risk Assessment Tool showed no significant difference in the 10-year risk of osteoporotic fractures in the two groups. On univariate and multivariate analyses, the only predictors of osteoporosis development were the prognostic scores of liver disease and BMI.

Conclusion Both tenofovir and entecavir are effective in treating HBV in cirrhotic patients. The known effects of tenofovir on BMD do not worsen osteoporotic fractures risk compared with entecavir in these patients.

aUnit of Internal Medicine 5 and Hepatology (UIMH), Department of Medicine (DIMED)

bUnit of Internal Medicine 1, Department of Medicine (DIMED), University of Padova, Padova, Italy

Correspondence to Paolo Angeli, MD, PhD, Unit of Internal Medicine 5 and Hepatology (UIMH), Department of Medicine (DIMED), University of Padova, Via Giustiniani 2, 35100 Padova, Italy Tel: +39 049 821 2004; fax: +39 049 821 8676; e-mail:

Received July 22, 2017

Accepted September 11, 2017

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