Important note: Information in this article was accurate in September 2000. The state of the art may have changed since the publication date.
Osteoporosis is a disorder where bones become thinner and begin to degrade. As the bones become thinner and more porous, they weaken and can easily break. Osteoporosis is more common in women after menopause because of hormonal changes. Conditions which increase the risk of osteoporosis include the following:
Use of the following medications is linked to the development of weakened bones:
Alcohol abuse and smoking have also been linked to the development of osteoporosis.
Recently, thinning bones have been reported among a group of HIV+ people using anti-HIV therapy which included a protease inhibitor. None of these people had obvious risk factors for osteoporosis. This has led some researchers to speculate that use of anti-HIV therapy may be linked to the development of thin bones.
Now researchers in Spain have found that some people who received combination treatment for hepatitis C have also developed osteoporosis. Precisely why this happened is unclear and is under active investigation.
Doctors in Madrid, Spain, began their investigation after finding one Hep C patient who had osteoporosis. This patient had no risk factors for bone disease and his only medications were ribavirin and interferon-alpha.
Researchers enrolled 32 male subjects who were infected with hepatitis C virus (HCV) but did not have liver damage. Subjects ages ranged between 31 to 48 years, with the average being 41. Researchers divided the subjects into the following groups:
All subjects used interferon at a dose of 3 million units, three times weekly for one year. Subjects in the combination group also used ribavirin at a dose of 1,000 to 1,200 mg/day, for one year. Extensive blood tests as well as X-rays of bones were done during the study.
Compared to subjects receiving interferon only, subjects in the combination group had bones that were significantly thinner after one year of treatment. Four subjects in the combination group had such thin bones that they were diagnosed with osteoporosis.
Technicians conducted extensive measurements of hormonal levels during the study. Both groups of subjects had normal levels of the following hormones in their blood:
Strangely, subjects in the combination group had lower than-normal levels of calcium in their urine. Ordinarily, this would happen if not enough calcium was being absorbed in the intestine. Yet when doctors removed samples of the subjects' intestines for analysis, they found that the intestines appeared to be undamaged.
The researchers think that ribavirin somehow interfered with the movement of calcium from the intestine. They are conducting another study to find out the impact of ribavirin and interferon on bone growth, development and damage.
Finally, the Spanish team notes that doctors treating their patients with anti-HCV therapy should be on the lookout for the development of osteoporosis in some of their patients.
1. Tebas P, Powderly WG, Claxton S, et al. Accelerated bone mineral loss in HIV-infected patients receiving potent antiretroviral therapy. AIDS 2000 Mar 10;14(4):F63-7.
2. Solis-Herruzo JA, Castellano G, Fernandez I et al. Decreased bone mineral density after therapy with alpha interferon in combination with ribavirin for chronic hepatitis C. Journal of Hepatology 2000;33:812-817.
3. Marwick C. Consensus panel considers osteoporosis. JAMA 2000 Apr 26;283(16):2093-5.
20000909
CATE11008
Copyright © 2000 - TreatmentUpdate. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Editor, The Canadian AIDS Treatment Information Exchange, 555 Richmond St. West, Suite 505, Box 1104, Toronto, ON, M5V 3B1 • Phone: 416-203-7122 • Toll Free: 1-800-263-1638 • Fax: 416-203-8284 http://www.catie.ca.
ÆGiS is made possible through unrestricted grants from Boehringer Ingelheim, Elton John AIDS Foundation, iMetrikus, Inc., the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 2000. This material is designed to support, not replace, the relationship that exists between you and your doctor.
ÆGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.
Copyright ©1990, 2000. ÆGiS & the Sisters of Saint Elizabeth of Hungary. All materials appearing on ÆGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of ÆGIS, or the party credited as the provider of the content.