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 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/cm2) than in group 1 (1.108±0.08 g/cm2, 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.