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Putting Together the Pieces: Cirrhosis, Osteoporosis and Aging
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As progress marches on with new drugs and combinations thereof, physicians are beginning to look toward their patients with cirrhosis, especially decompensated cirrhosis, as the last of the truly difficult-to-treat populations.
In this month’s cover story, we spoke with the leading researchers who are hoping to bring sustained virologic response rates in patients with hepatitis C virus and cirrhosis to the same successful levels that we are now seeing in uncomplicated HCV patients.
Douglas T. Dieterich, MD, discusses “astounding” results seen in the latest studies where decompensation markers are markedly improved, while Jordan J. Feld, MD, MPH, touches on why patients with cirrhosis are that much more difficult to treat.
In our feature, we look at the less obvious connection between HCV and bone diseases such as osteoporosis. Experts suggest that hormones, metabolism of vitamin D and inflammation could all play a role in the bone weakness seen in many patients with HCV. Vincent Lo Re III, MD, MSCE, and others have shown increased fracture risk in patients with HCV and hope future studies can better prepare hepatologists and other providers of HCV care to screen their patients for bone loss.
Special considerations should also be given to the elderly patients who have HCV as Paul Martin, MD, AGAF, explains in his patient profile. Though there is debate on the definition of “elderly,” data shows patients older than age 65 years present with more complications and greater risk of mortality when diagnosed with HCV. With increased success in treatment, physicians are not only handling patients diagnosed at a later stage of life, but also those who are living longer with their disease. Both of these factors — age at contraction of HCV and duration of disease — affect outcomes for patients, from fibrosis to death.
Visit Healio.com/HCV and let us know how you are treating your patients with cirrhosis, those at risk for bone disease and the elderly.
— The Editors
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