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

Background/Aims: Several thousand patients with chronic hepatitis C have be en treated with interferon plus ribavirin. After observing a male patient w ho developed severe bone loss during this treatment, we studied skeletal st atus and bone mineral metabolism in patients on therapy with interferon plu s 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 interf eron 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: -1.7 6+/-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 t herapy. 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 p revention or amelioration of these defects.