DOI: https://dx.doi.org/10.18203/2320-6012.ijrms20221983
Published: 2022-07-27

Prevalence and risk factors of bone disease in patients with chronic pancreatitis: a cross sectional study

Nithin Ramesh Kaidabettu, Akilandeswari Alagan Ramasamy, Vivek Rathod, Kani Shaikh Mohamed, Anand A., Arun N.

Abstract


Background: Osteopenia and osteoporosis is a highly prevalent condition and presents a tremendous public health burden. The association of bone disease has been recognized in several diseases of the git, resulting in established guidelines for screening in patients with malabsorptive disorders such as inflammatory bowel disease (IBD) and celiac disease.  Increasingly, the risk of bone disease has been recognized in patients with chronic pancreatitis, who share similar risk factors as patients with other gastrointestinal disorders.

Methods: This single-centre study was carried out in Kilpauk medical college. This study population consisted of 47 patients who were image confirmed cases of chronic pancreatitis. History of smoking, alcohol use was taken, body mass index, fecal elastase was measured. Dual-energy X-ray absorptiometry scan was used to examine bone mineral density (BMD) for the lumbar spine and bilateral femoral neck.

Results: Of the 47 patients, 19 patients were chronic smokers and 28 patients had history of significant alcohol use. The prevalence of osteoporosis in patient group was 29.8% in patients with CP compared to Indian prevalence of 18.3% in previous studies. The prevalence of osteopenia was 48.9% in patients with CP compared to Indian prevalence of 49.9% in previous studies.

Conclusions: Bone disease in CP can be attributed to several risk factors which act synergistically in propagating abnormal bone metabolism. Osteoporosis and osteopenia are underappreciated sources of morbidity in patients with chronic pancreatitis. Bone health management guidelines are urgently required in patients with chronic pancreatitis.


Keywords


Chronic pancreatitis, DEXA scan, Osteoporosis

Full Text:

PDF

References


Binkley N. Osteoporosis in men. Arq Bras Endocrinol Metabol. 2006;50(4):764-74.

Barkin JA, Barkin JS. Chronic Pancreatitis and Bone Disease. J Clin Densitom. 2020;23(2):237-43.

Kuhlmann L, Poulsen JL, Kohler M. Osteoporosis in Chronic Pancreatitis Outpatients Associates with Several Risk Factors. J Pancreas. 2018;19(4):183-9.

Ahmed A, Deep A, Kothari DJ, Sheth SG. Bone disease in chronic pancreatitis. World J Clin Cases. 2020;8(9):1574-9.

Babhulkar S, Seth S. Prevalence of osteoporosis in India: an observation of 31238 adults. Int J Res Orthop. 2021;7(2):362-368.

Bang UC, Benfield T, Bendtsen F, Hyldstrup L, Beck Jensen JE. The risk of fractures among patients with cirrhosis or chronic pancreatitis. Clin Gastroenterol Hepatol. 2014;12(2):320-6.

Dujsikova H, Dite P, Tomandl J, Sevcikova A, Precechtelova M. Occurrence of metabolic osteopathy in patients with chronic pancreatitis. Pancreatology. 2008;8(6):583-6.

Prabhakaran A, Bhasin DK, Rana SS. Bone mineral metabolism and bone mineral density in alcohol related and idiopathic chronic pancreatitis. Trop Gastroenterol. 2014;35(2):107-12.

Haas S, Krins S, Knauerhase A, Löhr M. Altered bone metabolism and bone density in patients with chronic pancreatitis and pancreatic exocrine insufficiency. JOP. 2015;16(1):58-62.

Sikkens EC, Cahen DL, Koch AD. The prevalence of fat-soluble vitamin deficiencies and a decreased bone mass in patients with chronic pancreatitis. Pancreatology. 2013;13(3):238-42.

Olesen SS, Frandsen LK, Poulsen JL, Vestergaard P, Rasmussen HH, Drewes AM. The prevalence of underweight is increased in chronic pancreatitis outpatients and associates with reduced life quality. Nutrition. 2017;43-44:1-7.

Ahmed Ali U, Nieuwenhuijs VB, van Eijck CH. Clinical outcome in relation to timing of surgery in chronic pancreatitis: a nomogram to predict pain relief. Arch Surg. 2012;147(10):925-32.

Bellin MD, Lowe M, Zimmerman MB. Diabetes Mellitus in Children with Acute Recurrent and Chronic Pancreatitis: Data from the INternational Study Group of Pediatric Pancreatitis: In Search for a CuRE Cohort. J Pediatr Gastroenterol Nutr. 2019;69(5):599-606.

14. Martínez-Moneo E, Stigliano S, Hedström A, et al. Deficiency of fat-soluble vitamins in chronic pancreatitis: A systematic review and meta-analysis. Pancreatology. 2016;16(6):988-94.

Reid IR. Relationships between fat and bone. Osteoporos Int. 2008;19(5):595-606.

Reid IR. Relationships among body mass, its components, and bone. Bone. 2002;31(5):547-555.

Duggan SN, O'Sullivan M, Hamilton S, Feehan SM, Ridgway PF, Conlon KC. Patients with chronic pancreatitis are at increased risk for osteoporosis. Pancreas. 2012;41(7):1119-24.

Lips P, van Schoor NM. The effect of vitamin D on bone and osteoporosis. Best Pract Res Clin Endocrinol Metab. 2011;25(4):585-91.

Johansson H, Kanis JA, Odén A. A meta-analysis of the association of fracture risk and body mass index in women [published correction appears in J Bone Miner Res. 2017;32(11):2319.

Gray M, Di Brezzo R, Fort IL. The effects of power and strength training on bone mineral density in premenopausal women. J Sports Med Phys Fitness. 2013;53(4):428-36.

Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142-8.

Qiu J, Li C, Dong Z, Wang J. Is diabetes mellitus a risk factor for low bone density: a systematic review and meta-analysis. BMC Endocr Disord. 2021;21(1):65.

23. Nyman JS, Even JL, Jo CH, et al. Increasing duration of type 1 diabetes perturbs the strength-structure relationship and increases brittleness of bone. Bone. 2011;48(4):733-40.

Goswami R, Nair A. Diabetes mellitus, vitamin D and osteoporosis: Insights. Indian J Med Res. 2019;150(5):425-8.

Laitinen K, Lamberg-Allardt C, Tunninen R, Karonen SL, Ylikahri R, Välimäki M. Effects of 3 weeks' moderate alcohol intake on bone and mineral metabolism in normal men. Bone Miner. 1991;13(2):139-51.

Metcalf BW, Bey P, Danzin C, Jung MJ, Casara P, Vevert JP. Catalytic irreversible inhibition of mammalian ornithine decarboxylase (EC 4.1. 1.17) by substrate and product analogs. J Am Chem Society. 1978;100(8):2551-3.

Feitelberg S, Epstein S, Ismail F, D’Amanda C. Deranged bone mineral metabolism in chronic alcoholism. Metabolism. 1987;36(4):322-6.

Gonzalez-Calvín JL, Garcia-Sanchez A, Bellot V, Muñoz-Torres M, Raya-Alvarez E, Salvatierra-Rios D. Mineral metabolism, osteoblastic function and bone mass in chronic alcoholism. Alcohol Alcohol. 1993;28(5):571-9.

Kim MJ, Shim MS, Kim MK. Effect of chronic alcohol ingestion on bone mineral density in males without liver cirrhosis. Korean J Intern Med. 2003;18(3):174-80.

Spangler JG. Smoking and hormone-related disorders. Prim Care. 1999;26(3):499-511.

Law MR, Hackshaw AK. A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of a major effect. BMJ. 1997;315(7112):841-6.

Ward KD, Klesges RC. A meta-analysis of the effects of cigarette smoking on bone mineral density. Calcif Tissue Int. 2001;68(5):259-70.

Välimäki MJ, Kärkkäinen M, Lamberg-Allardt C. Exercise, smoking, and calcium intake during adolescence and early adulthood as determinants of peak bone mass. Cardiovascular Risk in Young Finns Study Group. BMJ. 1994;309(6949):230-5.

Ortego-Centeno N, Muñoz-Torres M, Jódar E, Hernández-Quero J, Jurado-Duce A, De la Higuera Torres-Puchol J. Effect of tobacco consumption on bone mineral density in healthy young males. Calcif Tissue Int. 1997;60(6):496-500.

McCulloch RG, Whiting SJ, Bailey DA, Houston CS. The effect of cigarette smoking on trabecular bone density in premenopausal women, aged 20-35 years. Can J Public Health. 1991;82(6):434-5.

Duggan SN, O'Sullivan M, Hamilton S, Feehan SM, Ridgway PF, Conlon KC. Patients with chronic pancreatitis are at increased risk for osteoporosis. Pancreas. 2012;41(7):1119-24.

Ramsey ML, Conwell DL, Hart PA. Complications of Chronic Pancreatitis. Dig Dis Sci. 2017;62(7):1745-50.