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Chronic Pancreatitis and Bone Disease.
Jodie A Barkin1, Jamie S Barkin1
1University of Miami, Leonard M. Miller School of Medicine, Department of Medicine, Division of Gastroenterology, Miami, FL USA.
Summary
Patients with chronic pancreatitis (CP) have a high risk of osteoporosis and fractures due to maldigestion and vitamin D deficiency. Early screening and treatment with pancreatic enzyme replacement therapy (PERT) can improve bone health.
Area of Science:
- Gastroenterology and Endocrinology
- Bone Metabolism and Nutrition
Background:
- Chronic pancreatitis (CP) patients exhibit a higher prevalence of osteoporosis and fracture risk compared to the general population.
- Bone disease in CP is multifactorial, influenced by age, low BMI, maldigestion from exocrine pancreatic insufficiency (EPI), and substance abuse.
Purpose of the Study:
- To review the epidemiology, pathophysiology, and treatment of bone disease in patients with chronic pancreatitis.
- To highlight the significant association between EPI, vitamin D deficiency, and osteopathy in CP patients.
Main Methods:
- Review of existing literature on CP-associated bone disease.
- Analysis of risk factors including maldigestion, vitamin D deficiency, and lifestyle factors.
- Evaluation of treatment strategies, focusing on pancreatic enzyme replacement therapy (PERT).
Main Results:
- Approximately two-thirds of CP patients present with osteopathy (osteopenia or osteoporosis).
- Vitamin D deficiency is particularly prevalent in CP patients with EPI.
- PERT improves Dual energy X-ray absorptiometry (DXA) values, vitamin D levels, and nutritional status.
Conclusions:
- Osteopathy is common and morbid in CP patients, necessitating early screening and regular monitoring.
- Treatment should focus on correcting maldigestion with PERT and supplementing fat-soluble vitamins.
- Addressing these factors can prevent severe clinical sequelae associated with bone disease in CP.
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