Kronik Hepatit B Tedavisinde Entekavir ve Tenofovir Disoproksilin Kemik Mineral Yoğunluğuna Etkisi

Öz Amaç:Kronik hepatit B enfeksiyonu (KHB) olması nedeniyle entekavir(ETV) veya tenofovir disoproksil fumarat (TDF) tedavisi alan hastalarda ilaçların osteoporoz ile ilişkisinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: 2016-2021 yılları arasında en az 12 ay boyunca ETV veya TDF tedavisi başlanan ve sonraki 12 ay içinde kemik mineral dansitometri (KMD) ölçümü yapılan hastaların demografik özellikleri ile antiviral ilaç kullanımının osteopeni/ osteoporoz ile ilişkisi retrospektif olarak değerlendirildi. Bulgular: Çalışmaya 92’si (%54,1) erkek, ortalama tanı yaşı 36,57 ± 14,88 yıl olan 170 hasta dâhil edildi. Hastaların 24’ü (%14,1) ETV, 146’sı (%85,9) ise TDF kullanıyordu. Ortalama KMD ölçüm yaşı 48,62 ± 13,4 yıl idi. Tanıdan itibaren KMD’ye kadar geçen süre ortanca 138,5 (15-373) ay idi. Erkek hastaların 14’ünde (%15,2), kadın hastaların ise 25’inde (%32,1) osteopeni/osteoporoz saptanırken, kadınlarda osteopeni/osteoporoz sıklığı anlamlı olarak daha yüksek idi (p=0,011). ETV ve TDF arasında osteopeni/osteoporoz sıklığı açısından anlamlı farklılık izlenmedi (p=0,112). KMD parametrelerinde Lomber spine(LS) KMD TDF kullananlarda anlamlı olarak daha yüksek idi (p=0,043). Tedavi başlandıktan sonra 12 ay içinde hiçbir hastaya KMD istenmezken, hastaların 6 ’sına (%3,5) tedavi başlandıktan sonraki 24 ay içinde, 8’ine (%4,7) 36 ay içinde, 25’ine de (%14,7) 60 ay içinde KMD istenmişti. Sonuç: TDF ve ETV kullanan hastalarda osteopeni/osteoporoz gelişimi açısından anlamlı farklılık saptanmadı. KHB’si olan hastaların kemik mineral ölçümlerinin düzenli ve uygun bir şekilde yapılmadığı saptandı.

Anahtar Kelimeler:

Kronik hepatit B, osteoporoz, tenofovir disoproksil fumarat, entekavir.

The Effect of Entecavir and Tenofovir Disoproxil on Bone Mineral Density in Chronic Hepatitis B Treatment

Background/Aim:Evaluation of the relationship between drugs and osteoporosis in patients receiving entecavir (ETV) or tenofovir disoproxil fumarate (TDF) treatment for chronic hepatitis B infection (CHB). Material and Method: The study included patients who received ETV or TDF treatment for at least 12 months between 2016 and 2021 and underwent bone mineral densitometry (BMD) measurement within 12 months after treatment. Demographic characteristics of the patients and the association of antiviral drug use with osteopenia/osteoporosis were retrospectively. Results: The study included 170 patients, 92 (54.1%) of whom were male, with a mean age at diagnosis of 36.57 ± 14.88 years. Of the patients, 24 (14.1%) were on ETV and 146 (85.9%) were on TDF. The mean age at BMD measurement was 48.62 ± 13.4 years. The median time from diagnosis to BMD was 138.5 (15-373) months. Osteopenia/osteoporosis was found in 14 (15.2%) of male patients and 25 (32.1%) of female patients. The frequency of osteopenia/osteoporosis was significantly higher in women (p=0.011). There was no significant difference in the frequency of osteopenia/osteoporosis between ETV and TDF (p=0.112). Lumbar spine (LS) BMD was significantly higher in TDF users (p=0.043). While no patient had a BMD within 12 months of treatment initiation, 6 (3.5%) of the patients had a BMD within 24 months, 8 (4.7%) within 36 months and 25 (14.7%) within 60 months of treatment initiation. Conclusion: There was no significant difference in the development of osteopenia/osteoporosis in patients using TDF and ETV. It was found that bone mineral measurements of patients with CHB were not performed regularly and appropriately.

Keywords:

Chronic hepatitis B, osteoporosis, tenofovir disoproxil fumarate, entecavir.,

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