Decreased bone mineral density after therapy with alpha interferon in combination with ribavirin for chronic hepatitis C

• Published in: Journal of hepatology Vol. 33; no. 5; pp. 812 - 817
• Main Authors: Solís-Herruzo, José A, Castellano, Gregorio, Fernández, Inmaculada, Muñoz, Raquel, Hawkins, Federico
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier B.V 01.11.2000; Elsevier
• Subjects: Biological and medical sciences; Bone Density - drug effects; Bone loss; Drug Therapy, Combination; Drug toxicity and drugs side effects treatment; Hepatitis C, Chronic - drug therapy; Humans; Interferon-alpha - administration & dosage; Interferon-alpha - adverse effects; Male; Medical sciences; Middle Aged; Osteopenia; Osteoporosis - chemically induced; Pharmacology. Drug treatments; Ribavirin; Ribavirin - administration & dosage; Ribavirin - adverse effects; Toxicity: osteoarticular system; Bone loss; Osteopenia; Ribavirin; Human; Drug combination; Alpha interferon; Cytokine; Diseases of the osteoarticular system; Hepatic disease; Bone disease; Infection; Chemotherapy; Chronic; Treatment; Viral disease; Immunotherapy; Digestive diseases; Complication; Bone defect; Viral hepatitis C
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/S0168-8278(00)80314-1

Background/Aims: Several thousand patients with chronic hepatitis C have been treated with interferon plus ribavirin. After observing a male patient who developed severe bone loss during this treatment, we studied skeletal status and bone mineral metabolism in patients on therapy with interferon plus ribavirin. Methods: Bone mineral density and biochemical bone markers were studied in 32 male patients (31–58 years old) treated for 12 months with either interferon alone (group 1; n=13) or interferon plus ribavirin (group 2; n=19). Results: Bone mineral density was significantly lower in group 2 (0.877±0.07 g/cm 2) than in group 1 (1.108±0.08 g/cm 2, p<0.001). Likewise, T- and Z-score values were also decreased in group 2 (T: −1.95±0.6. Z: −1.76±0.51) compared with group 1 (T: 0.19±0.6; p<0.001. Z: 0.26±0.6; p<0.001). Serum and urine biochemical bone markers were normal in both groups. However, urinary calcium excretion was decreased in patients on combined therapy. Conclusion: Treatment of chronic hepatitis C with interferon plus ribavirin may induce bone loss. This secondary effect should be investigated during the followup of these patients, since they may require therapies aimed at prevention or amelioration of these defects.