Bone mineral metabolism and bone mineral density in alcohol related and idiopathic chronic pancreatitis

Prabhakaran, Anusree

doi:10.7869/tg.189

Cited by 16 publications

(5 citation statements)

References 21 publications

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“…Patients with chronic pancreatitis are at risk of osteoporosis and fracture because of numerous factors such as deteriorating pancreatic exocrine function, maldigestion and malabsorption of nutrients (especially fat-soluble vitamins and micronutrients), chronic systemic inflammation, abnormal bone turnover and, for some patients, ongoing alcohol excess and smoking [ 8 ]. We found low BMD in 53.4% (osteopenia 28.0% and osteoporosis 25.4%) of patients during a mean follow-up of 7.6 years after diagnosis of CP (897.6 person-years), which is lower compared to studies from Ireland [ 8 , 9 ], Germany [ 10 ], USA [ 11 ] and India [ 12 ], but higher than experiences from the Czech Republic [ 13 ] ( Table 4 ). A systematic review and meta-analysis that included 10 studies and 513 patients with CP showed a pooled prevalence rate for osteoporosis or osteopenia of 65% (23.4% prevalence for osteoporosis and 39.8% for osteopenia) [ 3 ].…”

Section: Discussioncontrasting

confidence: 56%

Low Bone Mineral Density and Risk for Osteoporotic Fractures in Patients with Chronic Pancreatitis

et al. 2021

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Introduction: Chronic pancreatitis (CP) can lead to malnutrition, an established risk factor for low bone mineral density (BMD) and fractures. This study aims to determine the prevalence of low BMD, assess fracture incidence and explore risk factors for fractures in patients with CP. Patients and methods: We performed a retrospective analysis of all patients treated for CP at Karolinska University Hospital between January 1999 and December 2020. Electronic medical records were retrieved to assess demographic, laboratory and clinical data. Patients subjected to dual-energy X-ray absorptiometry (DXA) were categorised as either low BMD or normal BMD. We investigated whether the rate of fractures, defined by chart review, differed between these groups using Cox regression, adjusting the model for age, sex and body mass index (BMI). Additional within-group survival analysis was conducted to identify potential risk factors. Results: DXA was performed in 23% of patients with definite CP. Some 118 patients were included in the final analysis. Low BMD was present in 63 (53.4%) patients. Mean age at CP diagnosis in the total cohort was 53.1 years and was significantly lower in patients with normal BMD than in patients with low BMD (45.5 vs. 59.8, p < 0.001). Significant differences were observed in smoking status and disease aetiology, i.e., a higher proportion of patients with low BMD were current or former smokers, with nicotine or alcohol being a more common cause of CP (p < 0.05). Total follow-up time was 898 person-years. Fractures were found in 33 (28.0%) patients: in 5 of 55 patients (16.7%) with normal DXA and in 28 of 63 patients (44.4%) with low BMD (adjusted hazard ratio = 3.4, 95% confidence interval (CI) = 1.2–9.6). Patients with at least 3 months of consecutive pancreatic enzyme replacement therapy (PERT) or vitamin D treatment had a longer median time to fracture after CP diagnosis. Conclusion: DXA was only performed in 23% of patients with definite CP in this study, indicating a low adherence to current European guidelines. A low BMD was found in 53.4% of patients with CP, and 44% of the patients with a low BMD experienced a fracture during follow-up. Moreover, the fracture rate in patients with low BMD increased compared to those with normal BMD.

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Section: Discussioncontrasting

confidence: 56%

Low Bone Mineral Density and Risk for Osteoporotic Fractures in Patients with Chronic Pancreatitis

et al. 2021

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“…68,69 Given the high morbidity andmortality associated with fractures in older individuals and previous findings of osteopathy among CP patients, vitamin D supplementation is advisable. 30,49,70…”

Section: Discussionmentioning

confidence: 99%

Nutrition and Inflammatory Biomarkers in Chronic Pancreatitis Patients

Greer

Sandhu

et al. 2018

Nut in Clin Prac

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“…The contribution of comorbidities is illustrated by a study comparing patients having alcohol‐related pancreatitis to ones having idiopathic pancreatitis. As a group, patients with pancreatitis had low BMD, but no independent effect of alcohol abuse was noted (Prabhakaran et al., ). The inclusion of individuals with alcohol‐related secondary diseases may have contributed to variable results.…”

Section: Alcohol and Bonementioning

confidence: 99%

Alcohol: A Simple Nutrient with Complex Actions on Bone in the Adult Skeleton

Gaddini

Turner

Grant

et al. 2016

Alcoholism Clin & Exp Res

124

101

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Background Alcohol is an important nonessential component of diet, but the overall impact of drinking on bone health, especially at moderate levels, is not well understood. Bone health is important because fractures greatly reduce quality of life and are a major cause of morbidity and mortality in the elderly. Regular alcohol consumption is most common following skeletal maturity, emphasizing the importance of understanding the skeletal consequences of drinking in adults. Method This review focuses on describing the complex effects of alcohol on the adult skeleton. Studies assessing the effects of alcohol on bone in adult humans as well as skeletally-mature animal models published since the year 2000 are emphasized. Results Light to moderate alcohol consumption is generally reported to be beneficial, resulting in higher bone mineral density (BMD) and reduced age-related bone loss, whereas heavy alcohol consumption is generally associated with decreased BMD, impaired bone quality and increased fracture risk. Bone remodeling is the principle mechanism for maintaining a healthy skeleton in adults and dysfunction in bone remodeling can lead to bone loss and/or decreased bone quality. Light to moderate alcohol may exert beneficial effects in older individuals by slowing the rate of bone remodeling but the impact of light to moderate alcohol on bone remodeling in younger individuals is less certain. The specific effects of alcohol on bone remodeling in heavy drinkers is even less certain because the effects are often obscured by unhealthy lifestyle choices, alcohol-associated disease, and altered endocrine signaling. Conclusions Although there have been advances in understanding the complex actions of alcohol on bone, much remains to be determined. Limited evidence implicates age, skeletal site evaluated, duration and pattern of drinking as important variables. Few studies systematically evaluating the impact of these factors have been conducted and should be made a priority for future research. In addition, studies performed in skeletally mature animals have potential to reveal mechanistic insights into the precise actions of alcohol and associated co-morbidity factors on bone remodeling.

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Bone mineral metabolism and bone mineral density in alcohol related and idiopathic chronic pancreatitis

Abstract: Background: There is limited information on the bone mineral metabolism in patients with chronic pancreatitis (CP).

Cited by 16 publications

References 21 publications

Low Bone Mineral Density and Risk for Osteoporotic Fractures in Patients with Chronic Pancreatitis

Low Bone Mineral Density and Risk for Osteoporotic Fractures in Patients with Chronic Pancreatitis

Nutrition and Inflammatory Biomarkers in Chronic Pancreatitis Patients

Alcohol: A Simple Nutrient with Complex Actions on Bone in the Adult Skeleton

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