Chronic Pancreatitis and Bone Disease

Jodie A. Barkin, Jamie S. Barkin

Research output: Contribution to journalReview article

Abstract

Patients with chronic pancreatitis (CP) may have a higher prevalence of osteoporosis than the general population thereby increasing the risk of bone fracture. The pathophysiology of bone disease in CP is multifactorial. Their risk factors for secondary osteoporosis include increasing age, low body mass index from sitophobia, maldigestion due to exocrine pancreatic insufficiency (EPI) with resulting low vitamin D, as well as smoking and alcohol abuse. An obvious association of bone disease with CP is from EPI with maldigestion of fat-soluble vitamins including vitamin-D, which has a significant role in the process of bone formation. Vitamin-D deficiency may be higher in CP patients vs controls, and it is especially so in CP patients with EPI. Screening for CP-associated osteopathy, including osteopenia and osteoporosis, should be initiated early in the course of CP, as the overall prevalence of bone disease is approximately two-thirds of CP patients. Our initial approach in the treatment of osteoporosis should include correction of maldigestion resulting from EPI with use of pancreatic enzyme replacement therapy (PERT). PERT, which is the treatment for EPI is associated with improvement in Dual energy X-ray absorptiometry (DXA) values and vitamin-D levels compared to those who are not treated. This should improve, in addition to body mass index, vitamin-D deficiency and calcium absorption as well as improve overall nutritional status. Osteopathy is common in CP patients, has significant associated morbidity, should be screened for regularly, and corrected with fat soluble vitamin supplementation and PERT to prevent clinical sequelae. In this article, we review the epidemiology, pathophysiology, and treatment of bone disease in patients with CP.

Original languageEnglish (US)
JournalJournal of Clinical Densitometry
DOIs
StateAccepted/In press - Jan 1 2019
Externally publishedYes

Fingerprint

Bone Diseases
Chronic Pancreatitis
Chronic Disease
Exocrine Pancreatic Insufficiency
Enzyme Replacement Therapy
Osteoporosis
Vitamin D
Vitamin D Deficiency
Vitamins
Body Mass Index
Fats
Metabolic Bone Diseases
Bone Fractures
Photon Absorptiometry
Nutritional Status
Osteogenesis
Alcoholism
Epidemiology
Therapeutics
Smoking

Keywords

  • Bone disease
  • chronic pancreatitis
  • exocrine pancreatic insufficiency
  • osteoporosis
  • vitamin D deficiency

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Orthopedics and Sports Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Chronic Pancreatitis and Bone Disease. / Barkin, Jodie A.; Barkin, Jamie S.

In: Journal of Clinical Densitometry, 01.01.2019.

Research output: Contribution to journalReview article

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