Pancreaticoduodenectomy is associated with more progressive bone mineral density loss than distal pancreatectomy

Pancreatic resection can lead to the malabsorption of nutrients for bone metabolism. This study compared longitudinal changes in bone mineral density (BMD) between patients who underwent pancreaticoduodenectomy (PD) and those who underwent distal pancreatectomy (DP).

The subjects of this retrospective analysis were 153 patients who underwent pancreatic resection, as PD in 102 and as DP in 51, between July, 2017 and November, 2022, and survived for at least 3 years. BMD was measured in Hounsfield units (HU) at the 11th thoracic vertebra on routine CT imaging. Risk factors for significant BMD loss (ΔBMD > 20 HU) and longitudinal changes were evaluated.

The cumulative incidence of fractures 2, 4, and 6 years after pancreatic resection was 2.6%, 7.9%, and 13.5%, respectively. Multivariate analysis identified preoperative BMD > 103 HU (p = 0.001) and PD (p < 0.001) as independent risk factors for ΔBMD > 20 HU. Linear mixed-effects analysis demonstrated a greater decline in BMD after PD than after DP (p for interaction < 0.001), whereas no significant differences were observed in serum albumin levels or body weight. ΔBMD > 20 HU was significantly associated with a higher fracture incidence (p = 0.020).

PD is associated with a greater postoperative BMD loss than DP, highlighting the importance of proactive monitoring and interventions targeting bone metabolism.