Impact of Hepatitis C Infection on Bone Microstructure of Patients with Hemophilia

Background Reduced bone mineral density (BMD) is a common finding in patients with hemophilia (PWH). In addition to contributing risk factors for low BMD such as orthopedic joint status (OJS), BMI, mobility, and HIV infection, hepatitis C virus (HCV) infection has previously been described as a potential risk factor. Most studies have evaluated BMD by dual-energy X-ray absorptiometry (DXA), but impact on bone microstructure, assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT), has not been described.

Methods Clinical data, OJS, laboratory evaluation of bone metabolism, and HCV status, results of DXA and HR-pQCT were captured during routine check-up visits. Additionally, patients completed questionnaires on activity and lifestyle after informed consent.

Results A total of 80 male PWH (median age: 33 years, range: 18–77) were retrospectively analyzed, of whom 67 (84%) and 13 (16%) had hemophilia A and B, respectively. Fifty-four (68%), 6 (7%), and 20 (25%) had severe, moderate, or mild hemophilia, respectively; 35 (44%) were HCV positive. Of all PWH, 39% had an impaired bone microstructure at the distal radius, and 45% at the distal tibia. Comparing PWH based on their HCV status, HCV positive versus negative patients more often had a reduced volumetric BMD determined by HR-pQCT at the radius (26 vs. 1%, p = 0.002) and tibia (56% vs. 7%, p < 0.001) and an impaired bone microstructure at the tibia (68 vs. 34%, p = 0.006), with an increased prevalence of combined trabecular and cortical deficits (radius: 23 vs. 2%, p = 0.009; tibia: 24 vs. 5%, p = 0.018). Univariate analysis revealed significant worse values for trabecular BMD, trabecular thickness, trabecular separation at the radius and trabecular BMD, cortical BMD, trabecular number, and trabecular thickness at the tibia. Adjusted for age, BMI, OJS, and sporty activity, differences remained significant for trabecular density (radius: 85.9 ± 22.1 vs. 100.9 ± 17.7, p = 0.027; tibia: 74.8 ± 2.1 vs. 92.8 ± 16.7, p = 0.017) and trabecular thickness at the tibia (78.2 ± 17.2 vs. 88.7 ± 14.8, p = 0.007). No differences of BMD, as measured by DXA (spine, hip), were observed with regard to HCV status.

Conclusion Our data suggest an impact of HCV infection on trabecular volumetric BMD and bone microstructure in PWH, which might be caused by the negative impact of chronic inflammation on bone metabolism. HR-pQCT data may contribute to revealing insight into pathophysiological mechanisms involved in the development of osteoporosis in hemophilia.

Publication History

Article published online:
13 November 2020