Chronic pancreatitis linked to abnormal bone turnover

Last Updated: 2015-02-05

By Will Boggs MD

NEW YORK (Reuters Health) - Chronic pancreatitis and its attendant systemic inflammation are associated with abnormal bone turnover leading to reduced bone mineral density (BMD), researchers from Ireland report.

"Our previous studies showed that osteoporosis and osteopenia are common in young chronic pancreatitis patients," Dr. Sinead N. Duggan, from Trinity Centre for Health Sciences, Trinity College Dublin in Ireland, told Reuters Health by email. "The current study found that bone turnover was higher and is the first step in identifying potential therapies for this patient group."

High-sensitivity C-reactive protein (hsCRP), a measure of systemic inflammation, has been associated with BMD and fracture risk in healthy individuals, but the relationship between inflammation and BMD in patients with chronic pancreatitis has not been studied before now.

Dr. Duggan's team investigated the association between bone turnover, bone density, and systemic inflammation in a case-control study of 29 patients with chronic pancreatitis and 29 controls.

Among chronic pancreatitis patients, 31% had osteoporosis and 44.8% had osteopenia, compared with 6.9% and 51.7%, respectively, among controls.

Patients with chronic pancreatitis had lower BMD T-scores at all areas measured (lumbar vertebrae, right femoral neck, and total hip), according to the January 27 American Journal of Gastroenterology online report.

Compared with controls, patients had higher serum levels of procollagen 1 amino-terminal propeptide (P1NP) and osteocalcin (markers of bone formation), and more patients than controls had elevated levels of carboxy-terminal telopeptide of type I collagen (CTX-I, a marker of bone resorption).

Median hsCRP levels were more than three times as high among patients (3.15 mg/L) as among controls (0.9 mg/L), and IL-6 levels were more than twice as high (5.61 pg/mL versus 2.58 pg/mL). Twice as many patients as controls had elevations of at least 1 of these inflammatory markers.

Serum 25-hydroxy-vitamin D levels were significantly lower among patients than among controls, but the two groups did not differ significantly in parathyroid hormone levels.

Patients with low BMD had higher serum P1NP, parathyroid hormone, and IL-6 and lower serum vitamin D levels.

Low vitamin D levels were associated with high P1NP levels among patients, but not among controls, and serum hsCRP levels were significantly higher in patients with the lowest vitamin D levels.

"Arguably all patients with chronic pancreatitis should be screened for bone health," Dr. Duggan said. "At the very least men over 50 years, post-menopausal women, and those with difficult-to-treat malabsorption should be prioritized."

"However, bone health should not be looked at in isolation, but as part of a greater standardized assessment of nutritional status including exocrine/ endocrine evaluation, fat-soluble vitamin status (including vitamin D) and dietary assessment," she said.

"An improved understanding of the mechanisms of bone demineralization in chronic pancreatitis will allow for potential modification of risk factors, which may reduce bone loss in chronic pancreatitis, prevent osteoporosis, and ultimately reduce fracture risk," the researchers conclude.

Dr. Mandalam S. Seshadri, from Thirumalai Mission Hospital, Ranipet, India, has also studied osteodystrophy in patients with pancreatitis. He told Reuters Health by email, "In our study we found that the patients with severe steatorrhea were the ones who had the most severe bone disease."

"I do think that emphasizing smoking cessation would be very important and this is underscored by this study," Dr. Seshadri said. "Optimizing vitamin D status is important in improving bone health and in chronic pancreatitis with associated malabsorption. The supplementation of vitamin D may have to be parenteral, as absorption through the oral route may be defective."

This research was supported by the Health Research Board of Ireland. The authors report no conflicts of interest.

SOURCE: http://bit.ly/1zkF3m3

Am J Gastroenterol 2015.