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. 2023 Apr 13;23(1):124.
doi: 10.1186/s12876-023-02756-w.

Osteoporosis and sarcopenia are common and insufficiently diagnosed among chronic pancreatitis patients

Mikael Parhiala  1   2 , Mika Ukkonen  3   4 , Juhani Sand  3 , Johanna Laukkarinen  3   4
Affiliations

Osteoporosis and sarcopenia are common and insufficiently diagnosed among chronic pancreatitis patients

Mikael Parhiala et al. BMC Gastroenterol. .

Abstract

Purpose: Chronic pancreatitis (CP) leads to diabetes and pancreatic exocrine insufficiency (PEI). PEI may lead to maldigestion and malnutrition, which may cause fat-soluble vitamin deficiency, sarcopenia and abnormal bone density. We aim to study the prevalence of osteoporosis, sarcopenia and vitamin deficiency among CP patients.

Methods: Long-term (4-5 years) follow-up was implemented on CP patients. We recorded CP duration, BMI, smoking, alcohol consumption and medication. We determined the serum values for A, D and E vitamins, albumin, creatinine, haemoglobin, calcium and magnesium. Bone density measurement was taken from the proximal femur and lumbar spine. CT/MRI scans were used to measure for psoas muscle area.

Results: A total of 33 patients (median age 62 [39-81] years, 61% male) were included. None of these patients had earlier diagnosis of osteopathy, and none of them had known vitamin deficiency or were sarcopenic. Nineteen patients (57%) had pancreatic exocrine insufficiency and of these seven patients (37%) had no pancreatic enzyme replacement therapy (PERT) and one (5%) had inadequate enzyme therapy. During the study, osteoporosis was diagnosed in 20% and possible sarcopenia in 48% of patients. PEI and inadequate PERT was associated with low E vitamin levels (75% vs. 0%, p = 0.012), higher risk of osteoporosis (43% vs. 5.6%, p = 0.013) and sarcopenia (80% vs. 36%, p = 0.044).

Conclusion: This study demonstrates that chronic pancreatitis is associated with osteoporosis, sarcopenia and vitamin deficiency. If untreated, pancreatic exocrine insufficiency is associated with increased risk of these outcomes. This highlights the importance of identifying and treating PEI in CP patients.

Keywords: Alcohol; Bone mineral density; Exocrine insufficiency; Pancreatic enzyme replacement therapy; Pancreatic insufficiency; Psoas muscle area; Vitamin deficiency.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of patient selection in the study. We selected all chronic pancreatitis (CP) patients from 2014 and 2015 consecutively. All patients in the study had definitive diagnostic characteristics according to M-ANHHEIM. 1) Parhiala et al. 2020 Pancreatology
Fig. 2
Fig. 2
Boxplot of psoas muscle area (PMA). A Demonstrating a trend towards lower PMA with pancreatic exocrine insufficiency (PEI). B Demonstrates a lower PMA with disease duration of over 9 years despite there being no age difference
See this image and copyright information in PMC

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