Ribavirin enhances osteoclast formation through osteoblasts via up-regulation of TRANCE/RANKL.

Hepatitis C combination therapy comprising ribavirin and interferon-alpha causes dramatic improvement with the sustained virological response; however, this treatment may result in the loss of bone mineral density. To investigate the effects of ribavirin on bone cells, we examined osteoblast differentiation as well as the formation of osteoclasts from their precursors. Ribavirin enhances osteoclast formation through osteoblasts by up-regulation of TRANCE/RANKL gene expression, whereas it has no significant effect on either osteoblast differentiation or on bone formation. Understanding ribavirin's underlying mechanism of action on bone cells will enable the improved management of bone loss in chronic hepatitis C patients.