{
  "abstract": "Background Hepatitis B (HBV) is a huge global healthcare challenge, with an estimated 300 million people chronically infected, and is the leading cause of hepatocellular carcinoma worldwide. 1 Tenofovir (TDF) is an effective treatment for HBV but is recognised to reduce bone mineral density (BMD).2–4 International guidelines recommend fracture risk assessment in patients receiving TDF at baseline and periodically during the course of treatment.5 Method We investigated whether patients with chronic HBV (CHB) being treated with TDF in a large district general hospital had a fragility fracture risk assessment. Patients with CHB treated with TDF were identified using the hospital HBV database. Patients’ notes were reviewed for hospital visit encounters from November 2023 to November 2024, using electronic patient records (EPR), for documentation of vitamin D levels and calculation of individual fracture risk using the FRAX score. FRAX scores were then retrospectively calculated for all patients on TDF using data from EPR and community shared care records (Connected Care).Results Of 896 patients with CHB, 83 were treated with TDF. 45 patients were male and 38 were female, with a median age of 44 years. Most patients were of Asian origin (50 of 83). Six out of 83 patients (7.2%) had vitamin D levels checked within the stated timeframe. Of these, two (33.3%) were deficient with a level of less than 25 nmol/L and were given appropriate vitamin D replacement. One patient out of 83 (1.2%) had their FRAX score documented during clinic visits. 24 out of 83 patients (28.9%) had complete demographic data and fracture risk variables enabling calculation of their FRAX scores. Four out of 24 patients (16.7%) were assessed to have a low risk of an osteoporotic fracture, whilst 18 (75%) were deemed to have intermediate risk and two (8%) high or very high risk. Bone mineral density assessment using DEXA scan was indicated in 20 out of 24 patients (83.3%).Conclusion Overall, assessment of fracture risk for patients with HBV treated with TDF was very low. Furthermore, fracture risk variables and demographic data required to calculate FRAX scores was incomplete in primary and secondary care. Many patients on TDF met criteria for further bone mineral density assessment when FRAX assessment was performed retrospectively. This has led to the inclusion of the FRAX score as part of an EPR careset for patients with CHB receiving TDF.References Global Hepatitis Report 2017. Geneva: World Health Organization; 2017.Marcellin P, Wong DK, Sievert W, Buggisch P, Petersen J, Flisiak R, Manns M, Kaita K, Krastev Z, Lee SS, Cathcart AL, Crans G, Op den Brouw M, Jump B, Gaggar A, Flaherty J, Buti M. Ten-year efficacy and safety of tenofovir disoproxil fumarate treatment for chronic hepatitis B virus infection. Liver Int. 2019 Oct;39(10):1868–1875. doi: 10.1111/liv.14155. Epub 2019 Jul 10. PMID: 31136052.Baranek B, Wang S, Cheung AM, Mishra S, Tan DH. The effect of tenofovir disoproxil fumarate on bone mineral density: a systematic review and meta-analysis. Antivir Ther. 2020;25(1):21–32. doi: 10.3851/IMP3346. PMID: 32077867.Gill US, Zissimopoulos A, Al-Shamma S, Burke K, McPhail MJ, Barr DA, Kallis YN, Marley RT, Kooner P, Foster GR, Kennedy PT. Assessment of bone mineral density in tenofovir-treated patients with chronic hepatitis B: can the fracture risk assessment tool identify those at greatest risk? J Infect Dis. 2015 Feb 1;211(3):374–82. doi: 10.1093/infdis/jiu471. Epub 2014 Aug 25. PMID: 25156561.Guidelines for the prevention, diagnosis, care and treatment for people with chronic hepatitis B infection. Geneva: World Health Organization; 2024",
  "authors": [
    {
      "affiliations": [
        "Royal Berkshire NHS Foundation Trust, UK"
      ],
      "name": "Catriona Phillips"
    },
    {
      "affiliations": [
        "Royal Berkshire NHS Foundation Trust, UK"
      ],
      "name": "Juliet Burridge"
    },
    {
      "affiliations": [
        "Royal Berkshire NHS Foundation Trust, UK"
      ],
      "name": "Usaid Yousaf"
    },
    {
      "affiliations": [
        "Royal Berkshire NHS Foundation Trust, UK"
      ],
      "name": "Summer Clarke"
    },
    {
      "affiliations": [
        "Royal Berkshire NHS Foundation Trust, UK"
      ],
      "name": "Ricky Sinharay"
    }
  ],
  "title": "P173 Assessment of fracture risk in patients with chronic hepatitis B treated with tenofovir in a large district general hospital",
  "uid": "7e873487-6a8b-58e4-8a44-57e0c22c9067"
}