REVISTA ROMÂNÅ DE BOLI INFECºIOASE – VOLUMUL XVIII, NR. 4, AN 2015 138 Corresponding author: Ecaterina-Constanta Barbu, Academia HIV/SIDA, “Prof. Dr. Matei Balas” National Institute for Infectious Diseases, 1 Calistrat Grozovici Street, Bucharest E-mail: katybarbu@yahoo.com THE EFFECT OF CHRONIC VIRAL HEPATITIS B AND C ON BONE MINERAL DENSITY Ecaterina-Constanta Barbu 1,2 , Cristina-Emilia Chitu-Tisu 1,2 , Mihai Lazar 1,3 , Ramona Stefania Popescu 1,3 , Adrian Octavian Abagiu 3 , Daniela Adriana Ion 1 , Ioana Anca Badarau 1 1 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 2 “Dr. I. Cantacuzino” Clinical Hospital, Bucharest, Romania 3 “Prof. Dr. Matei Bals” National Institute for Infectious Diseases, Bucharest, Romania ARTICOLE ORIGINALE ABSTRACT Objectives. Chronic viral hepatitis B and C represent an important health burden all over the world. Reduced bone mineral density is an extrahepatic complication which has been found in patients with chronic liver dis- ease. The aim of our study was to identify bone mineral impairment (osteopenia/osteoporosis) and the risk factors that are correlated with its severity, in patients with chronic viral hepatitis B (CHB) and C (CHC). Material and methods. Anthropometric, biological parameters and bone mineral density (BMD) were mea- sured in 60 patients with CHB (n = 30) and CHC (n = 30). BMD was assessed using Dual Energy X-ray Ab- sorptiometry (DEXA) in the hip and lumbar spine regions, inclusively a whole scan (total body). Results. Sixty patients (mean age 44.93 years, range: 20-70) were enrolled, including 30 CHB patients (mean age 46.43 years, range: 20-70) and 30 CHC patients (mean age 43.43 years, range: 28-64). Forty of patients were men (66.66 %). Active smokers were 16 patients (26.66 %). Meanbody mass index (BMI) was 25.38 kg/m 2 (range: 16.70-38.40). At baseline, 21 of 60 (35%) of the patients had evidence of osteopenia and 4 of 60 (6.66%) of patients, respectively presented osteoporosis at LS. At total hip, 22 of 60 of the patients (36.66%) recorded osteopenia; osteoporosis was found at 7 patients (11.66%) at total hip assessment. Low BMD values at different regions correlated significantly with low BMI, smoking and liver fibrosis grade. Conclusions. Our results suggest that bone mineral metabolism disorders exist in patients with chronic viral hepatitis B and C who are active smokers, presenting low BMI and advanced liver fibrosis, even without liver cirrhosis. Keywords: osteodystrophy, osteoporosis, chronic viral hepatitis B, chronic viral hepatitis C, chronic liver disease, bone mineral density 3 INTRODUCTION Reduced bone mineral density, as an extrahe- patic complication, found in patients with chronic liver disease (CLD) is well known (1-3). This com- plication was defined as hepatic osteodystrophy (HO) (3) and commonly manifests as osteoporosis or osteopenia (4). The pathophysiology of this type of secondary osteoporosis still remains unclear (3). Many factors seem to be evolved in the occurrence of HO: chronic cholestasis (5) (especially in pa- tients with primary biliary cirrhosis), low levels of insulin-like growth factor-1 (IGF-1) (6,7), the af- fecting of system of the receptor activator of nucle- ar factor κappa B ligand (RANKL) and osteoprote- gerin (OPG) (8), vitamin D deficiency (9,10), sedentary lifestyle (11), low body mass index (BMI) (12), alcoholism (13), and the list is still opened. The prevalence of HO ranges from 12 to 55% in patients with chronic liver disease (3). Regarding the chronic viral hepatitis, the preva- lence (in Europe) was reported to be between 0.1- 7% for chronic hepatitis B and between 0.4-3.5% in general population for chronic hepatitis C, re- spectively (14).