From Journal of Viral Hepatitis Prospective Study of Bone Mineral Density and Metabolism in Patients With Chronic Hepatitis C During Pegylated Interferon Alpha and Ribavirin Therapy
For the complete article see: http://www.medscape.com/viewarticle/584281?src=mp&spon=3&uac=39980BG
"......In conclusion, osteopenia is present in a substantial proportion of CHC patients who have no established cirrhosis. Antiviral therapy with peginterferon and ribavirin leads to a significant on-treatment increase of BMD in most of the patients; this may hold out in those who achieve a sustained virological response. With respect to available in vitro data, this beneficial effect on bone metabolism may, at least in part, be directly attributed to peginterferon via inhibition of bone resorption and possibly to the lack of ongoing productive HCV replication. These findings have implications for antiviral strategies for subsequent stages of the disease, given that hepatic osteodystrophy may by then become a major clinical problem."
Very interesting, Mike. Medscape does come up with some good articles.
Seems like there have been many discussions on this board about tooth decay during tx. I thought for some time that the treatment for hep C was detrimental to bone density based on tooth decay. This article shows that INF and RIB have a positive impact on bone density. I have osteopenia and never attributed it to hep C. It has improved over the last couple of years -- but I started taking Fosamax just shortly before I started treating for hep C so it would be hard to tell if the treatment or the Fosomax was the factor leading to the improvement.
So back to the tooth decay on tx. I believe that is caused by the decrease in antibacterial saliva in the mouth which is so common on tx rather than the tx drugs.
Thanks for the article - think I will make a copy for my internist.
I treated for a while without any dental issues and I go to my dentist every three months religiously.
I did find this news interesting. It may present yet one more side effect of HCV and another benefit of treatment - or viral suppression or viral elimination.
Happy New Year Kathy.
Innaresting. I have been breaking bones like crazy over the last couple years. And in situations where maybe they shouldn't have broken. T-12 vertebrae in my back smashed (wedge fracture) while riding a horse.
Osteoporosis has been talked about at length since the early 1980's, when studies found it to be a public health issue. It is estimated that over 25 million people in the United States are affected by this condition. However, it is not osteoporosis, or thinning of the bones, that is the problem, but the risk of fracture, especially in the elderly. In the US, some 40% of women and 13% of men may sustain a fracture after age 50. More than 1.3 million fractures annually are attributed to osteoporosis. Among them are some 500,000 vertebral or spine fractures, 250,000 hip fractures, and 240,000 wrist fractures. The numbers are different in different countries: reported incidences of hip fractures are highest in the US and Northern Europe; intermediate in Mediterranean and Asian countries, and lowest in South Africa, particularly in the areas where people follow traditional ways of life. There are more fractures among city dwellers than among country folk. Over the past 40 or 50 years, the incidence of hip fractures has risen significantly worldwide.
Calcium, especially from milk products, has been universally recommended as the one main element needed to reduce the risk of fractures. However, that may be the wrong approach: there are more fractures in regions that consume milk products (US, Great Britain, Canada, Northern Europe), than in those that don’t (traditional Africa, China). The extensive Nurses Study at Harvard, which followed 78,000 nurses for more than 12 years, found that those who drink two or more glasses of milk per day have twice the risk of hip fracture than those who drink a glass a week or less. In fact, the authors of the study conclude that “it is unlikely that high consumption of milk or other food sources of calcium during mid-life will confer substantial protective effects against hip or forearm fractures.”  There are several other large-scale studies that show that high calcium intakes double the risk of hip fracture.  After all we’ve been told, how could this be?
The explanation for this confused state of affairs lies in understanding the structure and function of bones better. At this time, most people, including health professionals, think bone=calcium, so the solution seems obvious. But that is too simplistic. Physiologically, bones are composed of calcium phosphate salts (65%) for hardness, and a collagen matrix (35%), for flexibility. If a bone is placed in an acid bath and all the calcium is removed from it, leaving just the collagen matrix, when subjected to stress it will bend, not break. Conversely, if the collagen matrix is removed and all that remains are the calcium salts, when subjected to stress it will shatter. In other words: a bone with zero calcium will bend, not break, whereas a high calcium/low collagen-matrix bone would break easily. This is why excess calcium can indeed increase the risk of fracture! For good bone health, we need many other synergistic nutrients, what Ann Louise Gittelman, author of Supernutrition for menopause, calls “the bone-building nutrient team”: magnesium, phosphorus, boron, copper, manganese, zinc, plus the vitamins C, D, K, B6, and folic acid. In addition, we need sufficient amounts of protein for the collagen matrix, and healthful fats for Vitamin D absorption and protection against bone-destroying free radicals. To obtain Vitamin D, we need 30 minutes or more of sunlight, or at least daylight, every day, without sunscreen. That is because a SPF of 8 blocks 95% of the production of Vitamin D, on the skin, and anything higher blocks it all  .
In a nut shell what all this means to me is...just dont only load up on calcium only...we need all the other nutreints too,in order for the body to absorb the calcium...again...common sense...but..."common sense isnt that common"....LOL
Related, I asked my NP whether or not I should have dental implant work done on treatment. Her response was to wait as interferon can temporarily reduce bone density. Perhaps she base this on the following or simliar studies: http://www.ncbi.nlm.nih.gov/pubmed/11097491 or perhaps an anecdotal from her practice. That said, a very brief google shows more articles suggesting benefits rather than limitations from interferon. Still, her advice of only doing necessary major dental work during treatment-- as opposed to elective -- makes a lot of sense. Not just because of the possibility of loss of bone density, but because of our overall condition during treatment. I do not include filling cavities or teeth cleaning in this category. I had my teeth cleaned every three months on treatment along with some minor dental work.
Dr. Melissa Parker appears to agree with my NP in terms of avoiding certain kinds of dental work both before and after treatment. she doesn't talk about bone density per se, but she does talk about interferon sensitivity. See page 157
While we are the topic of bones and teeth....TRY THIS OUT
just after brushing and flossing your teeth...take a dental cleaning tool and gently go arond each tooth ,between the tooth and gum line...you will be amazed what you will see...if you dont have a dentist tool...use the very small scewdriver,the type you use on fixing watches ..my denist kept saing i have the cleanest teeth she has ever seen between visits...i told her what ive been doing....she saiid i was putiing her out of a job...
Interesting that the study you sight seems to say that the bone density decrease is much worse in patients who had both ribavirin and interferon than the patients who just had just the interferon.
Melissa Parker has some good points there - it's not so much the bone loss as the other nasty things interferon does to the mouth.
I was ready to get a tooth implant shortly before I started treating. When I told the specialist I wanted to hold off until after I was done with tx he said, in no uncertain terms, not to come back to him until I was clear (I think remission was the term he used). He said -- no elective surgeries - not while treating but while hep C positive. I fired him needless to say and have another doctor lined up but still haven't had the implant, the issue now being the Fosamax I take which can cause jaw issues when you do deep dental surgery.
sorry about your stupid and insensitive implants specialist. But just as well, the implant process extends for many months while implant takes into the bone. That's why even if you start right before treatment there still could be problems. If you need something done you got to get it done but if you can wait then wait. I I just recently finished the implant process -- crowns and all-- and frankly I've had second thoughts about at least one of the implants, that was more or less elective. Doesn't exactly feel as natural as before although I'm sure I'll get used to it with time. To do it again, I only would've done the one implant that was really necessary. Hope this finds you well and have a happy and healthy new year.
Actually, there are two cost of a dental implant. First, the cost of the implant itself, which can run between $1500 and $3000 per tooth. Unfortunately, that only leaves you with a titanium rod embedded into your bone. Now, you need a crown. and crowns for implants can cost more than normal crowns because as my dentist put it, there are more parts. Plus you will also probably want to use a higher quality Crown that also cost more. So forget the $2000 per tooth,depending upon where you live, and who you use, it can be closer to $5000-$6000 per two. So does that little space between your teeth bother you all out much. LOL.
this website suggests the cost can be as high as $15,000-$30,000. Sure glad I didn't go to their dentists. LOL. But seriously, anyone considering an implant should get ALL the costs in advance, including the implant itself, x-rays, plus crown work. Also, as the website notes, some implants are more complex than others, and you want to make sure that you have a firm cost estimate before your periodontist starts drilling. Personally, I made a couple of assumptions regarding cost prior to my implants, and like a good night out on the town these days, my estimate didn't quite cover things :)
On the last trial I was on, June-July 2008, part of that trial included a side study of bone density relating to treatment. Prior to the treatment drugs, I was given a baseline bone densitometry where they did the measurements, etc. I had some mild osteopenia. Following 29 days of treatment, I was given another bone densitometry and it showed more osteopenia than the previous scan prior to the treatment. It was recommended that I have follow-up on later scans to see if it has stabilized. It showed that I had osteopenia in my lower lumbar vertebra and my hips and some mildly in my neck. I am now on Vit. D and calcium supplements. I will probably get another bone densitometry in June and if it's stabilized not do anything else for now but, if it's worse I may have to look into adding something like Actonel. I'm not totally surprised considering all the treatments that I have gone through.
Almonds are also unique in that they provide various minerals that are essential for bone health. Calcium, magnesium, manganese, and phosphorus have been implicated in maintaining bone mineral density. Almonds are comparable to skim milk and cheddar cheese in the quantity of these bone-building minerals provided in one serving. Other protein sources like chicken, beef, peanut butter, and eggs don’t offer the same.
In a neat little package, nature has bound up essential health promoting nutrients in an almond. From high quality and highly absorbable protein to vitamin E and essential minerals, just one handful, about an ounce, of almonds can be an important part of a healthy, nutrient-dense diet.
Vitamin E - Almonds are an excellent source of vitamin E, an antioxidant that has been shown to decrease the risk for certain forms of cancer, heart disease and cataracts. Vitamin E is also needed for healthy blood cells and tissues.
Folic Acid - Almonds, like other fruits and vegetables, make an important contribution to a diet adequate in folic acid, or folate. This important B-vitamin can reduce the risk for neural tube defects (birth defects) and is necessary for making red blood cells. It may also protect against heart disease and stroke.
Protein - almonds contain protein which is necessary for healthy muscles, blood and organs, and it can also be used for energy.
Fiber - almonds are a good source of dietary fiber - the part of the plant foods that is not digested in the human body. Fiber appears to play a protective role against heart disease and diabetes, an d aids in the prevention of constipation, diverticulosis, and some forms of cancer, such as colon and rectal.
Iron - An ounce of almonds contains 6% of the recommended daily requirements of iron. This essential mineral helps carry oxygen to all of the body's cells and organs.
Zinc - An ounce of almonds contains 6% of the recommended daily requirements of zinc, which aids in wound healing and is involved in protein metabolism. Zinc is also important in the development of the reproductive system.
Copper - Almonds are a good source of copper. This mineral helps carry oxygen throughout the body and helps keep bones, blood vessels and nerves healthy. It may also protect against heart disease.
Magnesium - Almonds are an excellent source of magnesium, a mineral used in building bones, making protein, releasing energy from muscles and regulating body temperature. It's also needed for calcium and potassium balance in the body.
Phosphorous - Almonds are a good source of phosphorous - the second most abundant mineral in the body. This important mineral is needed for strong bones and teeth, and helps the body use protein, fat and carbohydrates.
Pytochemicals - Almonds, like all other plant foods contain phytochemicals. These plant chemicals may have protective effects against heart disease, cancer and other chronic diseases.
A forum friend pointed me to this post because I've been having some pretty severe issues with a a rear anchor tooth rotting under a fixed bridge. I was hoping to hear about some of the other experiences other people have had with teeth decaying during treatment, but, well, how can I say this? On one hand we have a published scientific journal article with excellent information about bone loss, and on the other hand we have nutrition information from a formerly fat guy who wants to sell you his secrets.
The question I have to ask myself is whether I really want to talk about my tooth on a thread that has become condescending. Yeah. It will be my Christmas present to myself for years to come. First the bridge gets cut off then the tooth is extracted. Then a temp removal bridge is made and I wait a year before I can have an implant. Then a new bridge is made. We're talking at least $20,000. I've already spent at least that much in restoration work.
The bridge was fine before tx. It seems like my gums have receded and have exposed parts of the roots that hold the crowns and bridges in place on every bottom tooth I have. I have kept my mouth fastidiously clean and almost own stock in Biotene at this point (for hygiene and mouth sores).
I wouldn't blame anyone for not wanting to share experiences on a thread that has sunk to the depths of banality, but there it is.
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