title: Assessment of bone mineral density in tenofovir-treated patients with chronic hepatitis B: can the fracture risk assessment tool identify those at greatest risk?
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.
authors.affiliation: Hepatology Unit, Centre for Digestive Diseases, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London.
authors.forename: Upkar S
authors.initials: US
authors.lastname: Gill
authors.affiliation: Department of Hepatology, Barts Health NHS Trust.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Zissimopoulos
authors.affiliation: Department of Hepatology, Barts Health NHS Trust.
authors.forename: Safa
authors.initials: S
authors.lastname: Al-Shamma
authors.affiliation: Department of Hepatology, Barts Health NHS Trust.
authors.forename: Katherine
authors.initials: K
authors.lastname: Burke
authors.affiliation: Department of Hepatology, Faculty of Medicine, Imperial College London, St Mary's Hospital, Paddington.
authors.forename: Mark J W
authors.initials: MJ
authors.lastname: McPhail
authors.affiliation: Department of Infectious Diseases, Brownlee Centre for Infectious and Communicable Diseases, NHS Greater Glasgow and Clyde, United Kingdom.
authors.forename: David A
authors.initials: DA
authors.lastname: Barr
authors.affiliation: Department of Hepatology, Barts Health NHS Trust.
authors.forename: Yiannis N
authors.initials: YN
authors.lastname: Kallis
authors.affiliation: Department of Hepatology, Barts Health NHS Trust.
authors.forename: Richard T C
authors.initials: RT
authors.lastname: Marley
authors.affiliation: Department of Hepatology, Barts Health NHS Trust.
authors.forename: Paul
authors.initials: P
authors.lastname: Kooner
authors.affiliation: Hepatology Unit, Centre for Digestive Diseases, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London.
authors.forename: Graham R
authors.initials: GR
authors.lastname: Foster
authors.affiliation: Hepatology Unit, Centre for Digestive Diseases, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London.
authors.forename: Patrick T F
authors.initials: PT
authors.lastname: Kennedy
mesh_terms: D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D015992:Body Mass Index; D015519:Bone Density / Q000187:drug effects*; D003430:Cross-Sectional Studies; D005260:Female; D006515:Hepatitis B virus / Q000187:drug effects; D019694:Hepatitis B, Chronic / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000009:adverse effects* / Q000627:therapeutic use*; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D012306:Risk; D018570:Risk Assessment / Q000379:methods; D000068698:Tenofovir
chemical_list: D063065:Organophosphonates; D018894:Reverse Transcriptase Inhibitors; D000068698:Tenofovir; D000225:Adenine
keywords: DEXA; FRAX; bone mineral density; chronic hepatitis B; tenofovir