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Infectious diseases
Research
Association between hepatitis C virus infection and osteoporotic fracture risk among postmenopausal women: a cross-sectional investigation in Taiwan
  1. Ming-Shyan Lin1,2,
  2. Po-Han Chen3,
  3. Po-Chang Wang1,2,
  4. Huang-Shen Lin4,
  5. Tung-Jung Huang5,6,
  6. Shih-Tai Chang1,2,
  7. Wen-Nan Chiu7,
  8. Mei-Yen Chen1,8,9
  1. 1 Department of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
  2. 2 Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
  3. 3 Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Yunlin, Taiwan
  4. 4 Department of Infectious Diseases, Chang Gung Memorial Hospital, Chiayi, Taiwan
  5. 5 Department of Pulmonary Disease and Critical Care, Chang Gung Memorial Hospital, Yunlin, Taiwan
  6. 6 Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
  7. 7 Department of Hepato-Gastroenterology, Chang Gung Memorial Hospital, Yunlin, Taiwan
  8. 8 Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
  9. 9 Department of Nursing, Chang Gung University, Taoyuan, Taiwan
  1. Correspondence to Professor Mei-Yen Chen; meiyen{at}gw.cgust.edu.tw

Abstract

Purpose Early low bone mass is a risk factor for osteoporotic fractures associated with multiple factors, including menopause and chronic liver diseases. Hepatitis C virus (HCV) also plays a major role in chronic liver disease and has many extrahepatic consequences, such as decreased bone mineral density (BMD). This study aimed to examine the hypothesis that HCV seropositivity is independently associated with menopausal BMD loss.

Methods This community-based, cross-sectional study was based in two rural townships in Yunlin County, Taiwan. A total of 636 menopausal women aged 45–80 years who underwent annual health checks were included. Viral markers of HCV, dual-energy X-ray absorptiometry and fracture risk assessment tool (FRAX) scores were measured. Logistic regression analysis was performed to assess the association between various predictors and the presence of low BMD.

Results The participants (median age: 65 years) had a HCV seropositivity rate of 32.2%. BMD was significantly lower in the HCV-seropositive participants in different anatomic locations than in the seronegative individuals (lumbar spine: −1.5 vs −1.1; total hip: −0.9 vs −0.6; femoral neck: −1.2 vs −1.0; p<0.05). HCV-seropositive subjects had higher rates of major osteoporotic fractures (11.3%±7.6%vs 9.0±6.8%; p<0.001) and hip fractures (3.4%±4.7%vs 2.3±4.9%; p=0.006) and a higher risk of lower BMD (osteopenia and osteoporosis) based on a multivariable regression analysis (adjusted OR: 1.8; 95% CI 1.16 to 2.81; p=0.009).

Conclusions HCV infection may be an independent risk factor for menopausal BMD loss and fractures predicted by FRAX.

  • FRAX score
  • hepatitis C virus
  • menopause
  • osteopenia
  • osteoporosis

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-021990

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    Footnotes

    • Contributors All authors reviewed the manuscript and completed final approval. Study concept and design: M-SL, P-HC, P-CW, H-SL, T-JH and M-YC; acquisition of data: P-CW, H-SL and S-TC; analysis and interpretation of data: W-NC and Y-YM; manuscript draft: M-SL and M-YC; critical revision of the manuscript for important intellectual content: P-HC, H-SL, T-JH and M-YC.

    • Funding The study was supported by a grant from the Taiwan Formosa Plastic Company (FCRPF690011) and Chang Gung Memorial Hospital (BMRP148) as well as (CMRPGMF0012).

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval Ethical approval was provided by the institutional review board of the ethical committee of Chang Gung Memorial Hospital (IRB: 104–9925C).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.