Males with Chronic Pancreatitis Have Less Osteoporosis

Pancreatic enzyme replacement therapy (PERT) was associated with less osteopathy in male chronic pancreatitis patients, according to findings published in the Journal of the Pancreas.

Researchers from the Karolinska Institutet in Stockholm, Sweden assessed 50 male patients with confirmed chronic pancreatitis in order to conduct a prospective study of maldigestion, bone metabolism, and bone mineral density in a population of patients with chronic pancreatitis. There were 36 patients out of the total that consumed/ abused alcohol, and 42 from the total that were smokers. The researchers further noted in the paper that pancreatic exocrine insufficiency (PEI) in chronic pancreatitis patients may lead to a lack of fat soluble vitamins, including vitamin D, due to maldigestion.

The patients underwent the fecal elastase 1 test, had blood and urine samples analyzed for parameters relating to pancreatitis, nutrition, endocrine status, and bone metabolism. Bone mineral density was measured and the patients also completed a standardized questionnaire for osteoporosis.

PEI was confirmed in 28 patients who met the clinical criteria, and those patients were receiving PERT. Half of the patients included in the study had bone pain, and 21 patients had a history of bone fractures. The authors explained that vitamin D serum and urine calcium were decreased in urine, though deoxypyridinoline concentrations were increased in urine. Additionally, normal measurements of serum calcium, bone specific alkaline phosphatase, and parathyroid hormone were found. There seemed to be no statistically significant correlation between 3 classes of fecal elastase 1 test (<100 µg/g; 100-200 µg/g; >200 µg/g) and calcium, vitamin D, or deoxypyridinoline.

There were 5 patients with normal bone density, 9 with osteopenia, and 1 patient with osteoporosis. Low fecal elastase scores were linked to low T scores and low bone mineral density in conventional X rays, the researchers found. The patients who received PERT also had significantly higher dual energy X ray absorption values.

“A significant decrease was seen in serum vitamin D, along with a significant increase in deoxypyridinoline in urine,” the authors concluded. “Bone mineral density was reduced in the majority of patients with chronic pancreatitis. There was a correlation between pancreatic exocrine function and bone mineral density. When patients receiving PERT were compared to those not receiving enzymes, the patients receiving PERT had significantly higher dual energy X-ray absorption scores.”