Comparative risk of osteoporosis and fractures in chronic hepatitis B patients: Tenofovir disoproxil fumarate vs. entecavir in a Korean nationwide cohort

Our study highlights the need for careful antiviral selection in patients with chronic hepatitis B aged ≥60 due to the increased risk of osteoporosis and fractures with long-term tenofovir disoproxil fumarate use. We recommend using entecavir or tenofovir alafenamide fumarate as the preferred therapies for patients at high risk of fractures. Early intervention is essential, as fracture incidence tends to rise after 2-3 years of tenofovir disoproxil fumarate therapy, making regular bone mineral density monitoring critical for these patients.