Bone Trouble Common in Chronic Pancreatitis Patients

More than half of chronic pancreatitis patients showed osteopathy on dual-energy x-ray absorptiometry (DXA) screening, researchers found in a prospective study.

In a cross-sectional analysis involving nearly 300 patients with confirmed chronic pancreatitis enrolled in the PROCEED study, DXA scans revealed osteopenia in 39% and osteoporosis in 17%, reported Darwin Conwell, MD, MSc, of the Ohio State University Wexner Medical Center in Columbus, and colleagues, writing in Clinical Gastroenterology and Hepatology.

Multivariate regression analysis showed that higher odds of osteopathy were associated with:

• White race (OR 2.68, 95% CI 1.20-6.01, P=0.017)
• Female sex (OR 3.08, 95% CI 1.75-5.43, P<0.001)
• Body mass index (BMI) <18.5 (OR 7.40, 95% CI 1.56-34.99, P<0.001)
• Older age (OR 1.29 per 5 years, 95% CI 1.15-1.45, P<0.001)

For individuals 50 and older, the prevalence of osteopathy was greater than 60%: 50-59 years, 66.3%; 60-75 years, 62.5%.

“Notably, abnormalities were also observed in one-third of subjects younger than 50 at baseline,” the researchers noted.

Conwell’s group pointed out that current screening guidelines from the U.S. Preventive Services Task Force could lead to missed diagnoses of osteopathy in chronic pancreatitis patients younger than 65.

“The high prevalence of osteopathy in chronic pancreatitis provides evidence to support screening for osteoporosis, including for patients who would otherwise not be considered as high risk,” the authors wrote.

No significant associations were found in the study between osteopathy and clinical disease features of chronic pancreatitis.

Samuel Y. Han, MD, also of the Ohio State University Wexner Medical Center, but who was not involved in the research, said the study “gives us insight into how a considerable number of patients, namely men and young females, who were previously thought to have a low risk of bone disease, do indeed have a high risk of bone disease if they have chronic pancreatitis.”

“The high risk of bone disease in chronic pancreatitis patients overall illustrates the need for both physicians and patients to be vigilant in monitoring bone health in addition to assessing bone health-related factors such as Vitamin D levels and malabsorption,” Han told MedPage Today.

“While the mechanism of reduced bone mineral density (BMD) in CP [chronic pancreatitis] is not completely understood, a number of factors, including overlapping risk factors for both diseases, such as cigarette smoking and heavy alcohol use, and direct or indirect effects from CP may be responsible for this finding,” the authors noted. “CP may indirectly contribute to the risk of reduced BMD through exocrine dysfunction leading to micronutrient deficiencies (especially vitamins D and K) and low body mass index, as well as decreased physical activity.”

For their study, the researchers evaluated 282 chronic pancreatitis patients (median age 56) from the ongoing PROCEED (Prospective Evaluation of Chronic Pancreatitis for Epidemiologic and Translational Studies) study, which involves nine centers and is part of the NIH-funded Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer.

All patients underwent a DXA scan at enrollment, from June 2017 to September 2020, unless they had a DXA scan within 3 years of study entry. The lowest T-scores, a measurement of BMD, were used to define osteopathy. Overall, 158 patients had osteopathy and 124 did not.

Chronic pancreatitis was confirmed by a CT scan showing Cambridge classification 3 or 4, histological findings, magnetic resonance cholangiopancreatography imaging, or presence of parenchymal or intraductal calcifications.

The vast majority of patients in the study were white (87%) and a little more than half were women. Median BMI was 23 for the osteopathy group and 26.6 for the normal group. Alcohol was attributed to 42% of the patients’ chronic pancreatitis, and about two-thirds of the cohort were past or current smokers.

Not surprisingly, traumatic and spontaneous fractures were more frequent in the osteopathy group versus normal group, respectively:

• Traumatic: 40% vs 26% (P=0.02)
• Spontaneous: 4% vs 0% (P=0.04)

“Staying on top of these patients’ bone health could play a significant role in preventing fractures in this population, but more studies are needed to determine how chronic pancreatitis accelerates bone loss,” said Han.

The analysis had several limitations, the researchers acknowledged, including that patients tended to be older at enrollment, potentially overestimating osteopathy prevalence in this population. Also, fat-soluble vitamin deficiency variables were not assessed and the effect of exocrine pancreatic insufficiency on chronic pancreatitis was not adequately evaluated.

Last Updated September 28, 2021