title: Males seropositive for hepatitis B surface antigen are at risk of lower bone mineral density: the 2008-2010 Korea National Health and Nutrition Examination Surveys.
abstract: BACKGROUND
  Hepatic osteodystrophy has been reported in patients with various chronic liver diseases, including liver cirrhosis. However, it has not been well investigated in patients with hepatitis B virus infection. The aim of this study was to investigate the association between hepatitis B surface antigen (HBsAg) seropositivity and bone mineral density (BMD) in a population representative of normal Koreans.
  
  
  METHODS
  Subjects with both HBsAg and BMD levels examined during the 2008-2010 Korea National Health and Nutrition Examination Surveys were included. HBsAg-seropositive (+) subjects were compared with those who were HBsAg-seronegative (-). BMD was measured at the lumbar spine and femur by dual-energy X-ray absorptiometry. Multivariable logistic regression was performed for BMD .
  
  
  RESULTS
  In total, 11,306 participants were included in this study, among which 423 (3.7 %) were HBsAg(+): 153 premenopausal female (3.4 %), 83 postmenopausal female (3.5 %), and 187 male (4.2 %). Multivariable logistic regression analysis adjusted for age and body mass index showed that HBsAg(+) male had significantly lower BMD of the femoral neck than HBsAg(-) male (0.810 ± 0.009 vs. 0.827 ± 0.002 g/cm(2), p = 0.035). Further adjustment for waist circumference, smoking, drinking, exercise, income, occupation, and vitamin D levels showed that HBsAg(+) male had significantly lower BMD of the femur neck (0.810 ± 0.010 vs. 0.831 ± 0.002 g/cm(2), p = 0.032) and lumbar spine (0.953 ± 0.011 vs. 0.974 ± 0.003 g/cm(2), p = 0.049) than HBsAg(-) male.
  
  
  CONCLUSIONS
  HBsAg seropositivity was significantly associated with lower BMD in male. Future long-term prospective studies investigating bone turnover markers and hormones are needed to better understand the pathophysiology and clinical significance of chronic hepatitis B virus-related hepatic osteodystrophy.
authors: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul, 137-701, South Korea.
authors: Myong Ki
authors: MK
authors: Baeg
authors: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul, 137-701, South Korea. yoonsk@catholic.ac.kr.
authors: Seung Kew
authors: SK
authors: Yoon
authors: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul, 137-701, South Korea.
authors: Sun-Hye
authors: SH
authors: Ko
authors: Department of Biostatistics, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul, 137-701, South Korea.
authors: Kyung-Do
authors: KD
authors: Han
authors: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul, 137-701, South Korea.
authors: Hye Jin
authors: HJ
authors: Choi
authors: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul, 137-701, South Korea.
authors: Si Hyun
authors: SH
authors: Bae
authors: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul, 137-701, South Korea.
authors: Jong Young
authors: JY
authors: Choi
authors: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul, 137-701, South Korea.
authors: Myung-Gyu
authors: MG
authors: Choi
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D015519:Bone Density; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D005272:Femur Neck / Q000473:pathology; D006509:Hepatitis B / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006801:Humans; D016015:Logistic Models; D008297:Male; D009749:Nutrition Surveys; D056910:Republic of Korea
chemical_list: D006514:Hepatitis B Surface Antigens
keywords: Bone mineral density; Hepatic osteodystrophy; Hepatitis B virus; Osteoporosis; Viral hepatitis