Hepatitis C-Associated Osteosclerosis: Improvement After Treatment with Sofosbuvir, Daclatasvir, and Ibandronate: Case Report and Literature Review

Hepatitis C-associated osteosclerosis (HCAO) remains a rare condition despite the growing prevalence of hepatitis C virus (HCV) infection worldwide. Since the first case reported in 1992, this is the twenty-second case described. Patients with HCAO present with severe bone pain and elevated serum levels of bone markers, especially alkaline phosphatase (ALP), with increased bone density. We report here the case of a 59-year-old man with generalized bone pain and diagnosis of HCV infection. Biochemical tests showed elevated bone turnover markers, specifically, ALP, carboxy-terminal collagen crosslinks and osteocalcin. Imaging studies revealed generalized bone sclerosis. Bone mineral density was elevated in all validated sites. His clinical symptoms and bone-related findings were attributed to HCAO. He was sequentially treated with cholecalciferol, prednisone, sofosbuvir associated with daclatasvir and ibandronate, and progressed with undetectable viral load after HCV treatment, normalization of ALP levels after introduction of ibandronate, and pain improvement 1 year after discontinuation of the bisphosphonate. Bone pain complaints must be investigated in patients with HCV. HCAO is a differential diagnosis of increased bone mass.