It’s important to consider renal and bone risk factors when managing your chronic hepatitis B patients

Renal 
Bone

Bone density may decline over time due to various factors. In addition, patients with chronic hepatitis B have a higher prevalence of osteoporosis and/or bone fracture than uninfected people1

bone risk factors diagram

BMD=bone mineral density.

a Based on claims from national insurance databases covering Commercial, Medicare, and Medicaid beneficiaries (2006-2015) in 44,026 chronic hep B patients and 121,568 non-chronic hep B patients. The databases contained medical and pharmacy claims for healthcare services performed in both inpatient and outpatient settings. The 2015 cohort included 11,372 patients and 32,110 non-chronic hep B patients.1

Consider other risk factors that may impact bone mineral density

Gender

~1 in 2 women and >1 in 3 men over 50 have low bone mass at femoral neck or lumbar spine, according to an observational study performed on the NHANES data gathered from 20103

(Wright NC, et al, 2014, N=99,048,838)

Ethnicity

Asian adults over 50 have a higher prevalence of osteoporosis than other ethnicities, such as Hispanic or non-Hispanic White/Black adults, according to an observational study of NHANES data from 2005-20144

(Looker AC, et al, 2017, N=7,954)

Low BMI

~2X higher prevalence of low BMI in Asian adults vs other ethnicities, such as Hispanic or non-Hispanic White/Black adults, according to the cross-sectional study analyses of adults aged 18 years or older in the US Behavioral Risk Factor Surveillance System surveys (2013-2020)5

(Shah NS, et al, 2022, N=2,882,158)

Smoking

Smoking was shown to increase the risk of bone fracture and reduce bone mass, according to a 2018 review of 27 studies6

(Al-Bashaireh AM, et al, 2018)

>1 in 10 chronic hepatitis B patients were current smokers, based on the prospective, observational study of tobacco consumption in people with chronic hepatitis B infection7

(Brahmania M, et al, 2020; data gathered between January 2011 and May 2016, n=1330)

Excessive alcohol consumption

Increased alcohol consumption is associated with higher risk of osteoporotic hip fractures8

(Godos J, et al, 2022; meta-analysis of 11 studies including 46,916 individuals with BMD assessment and 8 studies including 240,871 individuals)

~1 in 12 chronic hepatitis B patients were heavy drinkers, based on the prospective, observational study of alcohol consumption in people with chronic hepatitis B infection7

(Brahmania M, et al, 2020; data gathered between January 2011 and May 2016, n=1330)

Sedentary behavior

Replacing sedentary time with physical activity provides health benefits for people living with chronic conditions, including improved bone health9

(World Health Organization, 2022)

>1 in 2 adults have a high prevalence of daily sedentary behavior, according to a cross-sectional study based on NHANES data from 2001-201610

(Yang L, et al, 2019, N=51,896)

Antidepressants
 

An association between SSRI use and reduced BMD was observed in a 2012 review of 19 studies11

(Sansone RA, et al, 2012; review of studies related to bone fractures and osteoporosis in patients on SSRIs)

>1 in 8 adults used antidepressants12

(NCHS Data Brief, 2020, N=11,848; NHANES data from 2015-2018)

Proton pump inhibitors

Chronic PPI use may increase the risk of vertebral fracture by 40% to 60%, according to a 2012 review of 14 observational studies from 1980-201113

(Lau YT, et al, 2012)

Of the general US population, ~1 in 10 adults used a PPI, according to NHANES data from 2009-201314

(Devraj R, et al, 2020, N=18,504)

BMI=body mass index; NCHS=National Center for Health Statistics; NHANES=National Health and Nutrition Examination Survey; PPI=proton pump inhibitor; SSRI=selective serotonin reuptake inhibitor.

See risk factors that may impact renal function

Effect of VEMLIDY on renal safety parameters15,16

See pivotal and 8-year follow-up data

Impact of VEMLIDY on bone mineral density15,16

See pivotal and 8-year follow-up data

References: 1. Nguyen MH, Lim JK, Ozbay AB, et al. Advancing age and comorbidity in a US insured population-based cohort of patients with chronic hepatitis B. Hepatology. 2019;69(3):959-973. doi:10.1002/hep.30246 2. Cooper C, Ferrari S; IOF Board and Executive Committee. IOF Compendium of Osteoporosis, 2nd ed. International Osteoporosis Foundation; 2019. 3. Wright NC, Looker AC, Saag KG, et al. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res. 2014;29(11):2520-2526. doi:10.1002/jbmr.2269 4. Looker AC, Sarafrazi Isfahani N, Fan B, Shepherd JA. Trends in osteoporosis and low bone mass in older US adults, 2005-2006 through 2013-2014. Osteoporos Int. 2017;28(6):1979-1988. doi:10.1007/s00198-017-3996-1 5. Shah NS, Luncheon C, Kandula NR, et al. Heterogeneity in obesity prevalence among Asian American adults. Ann Intern Med. 2022;175(11):1493-1500. doi:10.7326/M22-0609 6. Al-Bashaireh AM, Haddad LG, Weaver M, Chengguo X, Kelly DL, Yoon S. The effect of tobacco smoking on bone mass: an overview of pathophysiologic mechanisms. J Osteoporos. 2018;2018:1206235. doi:10.1155/2018/1206235 7. Brahmania M, Liu S, Wahed AS, et al. Alcohol, tobacco and coffee consumption and liver disease severity among individuals with chronic hepatitis B infection in North America. Ann Hepatol. 2020;19(4):437-445. doi:10.1016/j.aohep.2020.01.005 8. Godos J, Giampieri F, Chisari E, et al. Alcohol consumption, bone mineral density, and risk of osteoporotic fractures: a dose-response meta-analysis. Int J Environ Res Public Health. 2022;19(3):1515. doi:10.3390/ijerph19031515 9. World Health Organization. Physical activity. Published June 26, 2024. Accessed October 21, 2025. https://www.who.int/news-room/fact-sheets/detail/physical-activity 10. Yang L, Cao C, Kantor ED, et al. Trends in sedentary behavior among the US population, 2001-2016. JAMA. 2019;321(16):1587-1597. doi:10.1001/jama.2019.3636 11. Sansone RA, Sansone LA. Antidepressant adherence: are patients taking their medications? Innov Clin Neurosci. 2012;9(5-6):41-46. 12. Brody DJ, Gu Q. Antidepressant use among adults: United States, 2015-2018. NCHS Data Brief. 2020;(377):1-8. 13. Lau YT, Ahmed NN. Fracture risk and bone mineral density reduction associated with proton pump inhibitors. Pharmacotherapy. 2012;32(1):67-79. doi:10.1002/PHAR.1007 14. Devraj R, Deshpande M. Demographic and health-related predictors of proton pump inhibitor (PPI) use and association with chronic kidney disease (CKD) stage in NHANES population. Res Social Adm Pharm. 2020;16(6):776-782. doi:10.1016/j.sapharm.2019.08.032 15. VEMLIDY Prescribing Information. Foster City, CA: Gilead Sciences, Inc.; March 2024. 16. Buti M, Lim YS, Chan HLY, et al. Eight-year efficacy and safety of tenofovir alafenamide for treatment of chronic hepatitis B virus infection: final results from two randomised phase 3 trials. Aliment Pharmacol Ther. 2024;60(11-12):1573-1586. doi:10.1111/apt.18278