Hofmann WP et al. (2008) Prospective study of bone mineral density and metabolism in patients with chronic hepatitis C during pegylated interferon alpha and ribavirin therapy. J Viral Hepat 15: 790–796

The association between osteoporosis and cirrhosis is well known; however, the prevalence of osteoporosis and the effects of antiviral treatments on bone metabolism of noncirrhotic patients with chronic hepatitis C (CHC) are unclear. A prospective study by Hofmann et al. investigated bone mineral density (BMD) and bone metabolism in 30 consecutive noncirrhotic patients with CHC who received antiviral therapy with pegylated interferon α2a and ribavirin. BMD and levels of the serum bone metabolism markers osteocalcin and procollagen type I C-terminal propeptide were measured at baseline, after 48 weeks of therapy, and after 24 weeks of follow-up.

At baseline, 43% of patients had osteopenia and 13% had osteoporosis. By the end of treatment, BMD at the hip and lumbar spine had significantly increased in 75% and 83% of patients, respectively. BMD declined after cessation of treatment, but remained above baseline values in patients with a sustained virological response. By contrast, BMD returned to baseline values in patients who had virologically relapsed at the 24-week follow-up. Levels of osteocalcin and procollagen type I C-terminal propeptide revealed a decrease in bone turnover during treatment.

This study demonstrates that a substantial proportion of patients with CHC who do not have established cirrhosis do have low BMD. The response of BMD and bone metabolism markers to antiviral therapy suggests that the treatment and/or the virus directly modulates bone metabolism.