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

Abstract

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.

Association between Osteoporosis and Low Hemoglobin Levels: A Nested Case–Control Study Using a National Health Screening Cohort

“…Thus, the predictive factors for fracture risk and osteoporosis have been investigated by many researchers. Low BMD has been reported to be associated with aging, low body weight, physical inactivity, smoking, excessive alcohol consumption, diabetes, dyslipidemia, and pernicious anemia [5][6][7]. In addition, chronic iron-deficiency anemia has been suggested to induce bone resorption and increase the risk of osteoporosis [8].…”

Pancreatic enzyme treatment in chronic pancreatitis: Quality of management and adherence to guidelines–A cross‐sectional observational study

“…Vitamin A , E and K are reduced in fat malabsorption and can be used to monitor malnutrition in PEI due to CP 47 . Osteoporosis because of malnutrition in PEI can be monitored by bone density measurements, as recommended in the UEG guidelines 25 . Al these parameters were not available.…”

“…It is notoriously underdiagnosed and undertreated. Since the consequences due to the resulting malnutrition can be severe, such as osteoporosis 25 and cardiovascular events, 26 adequate pancreatic enzyme replacement therapy (PERT) is pivotal and emphasized by the guidelines. 11 In this large cross‐sectional study, we found variable adherence to the recommendations of PERT from the UEG guidelines in this large cohort from dedicated specialist centers.…”

“… 47 Osteoporosis because of malnutrition in PEI can be monitored by bone density measurements, as recommended in the UEG guidelines. 25 Al these parameters were not available.…”

IL-6 and Leptin Are Potential Biomarkers for Osteoporotic Fracture Risk Assessment and Prediction of Postmenopausal Women with Low Bone Mass: A Follow-Up Study Using a Regional Sample Cohort

“…Many medicines are used to treat osteoporosis and repair the bone tissue by alleviating the expression of tissue inflammatory factors [33][34][35]. Meanwhile, inflammatory factors infiltration caused by many inflammatory diseases can also lead to abnormal bone metabolism, resulting in increased fracture probability, such as chronic pancreatitis [36,37], chronic enteritis [38], hepatitis [39], and chronic obstructive pulmonary disease [40]. IL-6 is a common inflammatory factor whose effect on bone metabolism has been confirmed already [41].…”