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. 2021 Jul 13;13(7):2386.
doi: 10.3390/nu13072386.

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

Miroslav Vujasinovic  1   2 , Lorena Nezirevic Dobrijevic  2 , Ebba Asplund  2 , Wiktor Rutkowski  1   3 , Ana Dugic  2 , Mashroor Kahn  2 , Ingrid Dahlman  2 , Maria Sääf  4 , Hannes Hagström  1   2   5 , Johannes-Matthias Löhr  1   3
Affiliations

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

Miroslav Vujasinovic et al. Nutrients. .

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.

Keywords: PERT; bone mineral density; chronic pancreatitis; fracture; osteoporosis.

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Conflict of interest statement

M.K.,E.A., L.N.D., A.D., W.R., H.H., M.S., I.D.: none. M.V.: lecture fees Mylan, Abbott. J.-M.L.: lecture fees Mylan, Abbott. The authors declare no conflict of interest regarding the present study.

Figures

Figure 1
Figure 1
Flow chart of patient selection (CP = chronic pancreatitis; BMD = bone mineral density; DXA = dual-energy X-ray absorptiometry).
Figure 2
Figure 2
Distribution of fractures by bone mineral density (BMD). Fractures in both groups were evenly distributed among body regions, with hip, vertebra and wrist fractures being more prominent overall.
Figure 3
Figure 3
Kaplan–Meier curve of estimated cumulative fracture events for patients stratified by bone mineral density (normal BMD vs. low BMD). BMD = bone mineral density.
See this image and copyright information in PMC

References

    1. Löhr J.M., Dominguez-Munoz E., Rosendahl J., Besselink M., Mayerle J., Lerch M.M., Haas S., Akisik F., Kartalis N., Iglesias-Garcia J., et al. United european gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (hapaneu) United Eur. Gastroenterol. J. 2017;5:153–199. doi: 10.1177/2050640616684695. - DOI - PMC - PubMed
    1. Peck W.A. Consensus development conference: Diagnosis, prophylaxis, and treatment of osteoporosis. Am. J. Med. 1993;94:646–650. doi: 10.1016/0002-9343(93)90218-E. - DOI - PubMed
    1. Duggan S.N., Smyth N.D., Murphy A., Macnaughton D., O’Keefe S.J., Conlon K.C. High prevalence of osteoporosis in patients with chronic pancreatitis: A systematic review and meta-analysis. Clin. Gastroenterol. Hepatol. 2014;12:219–228. doi: 10.1016/j.cgh.2013.06.016. - DOI - PubMed
    1. Kanakis A., Vipperla K., Papachristou G.I., Brand R.E., Slivka A., Whitcomb D.C., Yadav D. Bone health assessment in clinical practice is infrequenty performed in patients with chronic pancreatitis. Pancreatology. 2020;20:1109–1114. doi: 10.1016/j.pan.2020.07.396. - DOI - PMC - PubMed
    1. Kanis J.A., Cooper C., Rizzoli R., Reginster J.Y. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos. Int. 2019;30:3–44. doi: 10.1007/s00198-018-4704-5. - DOI - PMC - PubMed

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