People With Chronic Pancreatitis Often Miss Bone-Health Tests

By Anne Harding

September 03, 2020

NEW YORK (Reuters Health) - People with chronic pancreatitis frequently go without recommended bone-health surveillance, new findings suggest.

"Chronic pancreatitis is associated with an increased risk of metabolic bone disease. Therefore, screening for this condition is an important part of managing these patients. Unfortunately, we don't do that well," Dr. Julia McNabb-Baltar of Brigham and Women's Hospital and Harvard Medical School in Boston told Reuters Health by email.

Most patients with chronic pancreatitis develop metabolic bone disease due to malabsorption and vitamin D deficiency, and the American Gastroenterological Association recommends that they have baseline vitamin D testing and dual energy x-ray absorptiometry (DEXA), Dr. McNabb-Baltar and her team note.

"However, formal guidelines for bone health assessment have not been established in chronic pancreatitis patients," they write in Digestive Diseases and Sciences.

The researchers performed a chart review of 256 patients diagnosed with chronic pancreatitis at their institution. Overall, 43% underwent DEXA and 82% had vitamin D testing. Among patients followed by primary-care practitioners, 28% had DEXA and 74% had vitamin D testing.

Gastroenterologists tested DEXA in 29% of patients and vitamin D in 76%. Pancreas specialists tested DEXA in 52% of patients and vitamin D in 86%.

Multivariate analysis showed that pancreas specialists were significantly more likely than PCPs to perform both tests, but the difference between pancreas specialists and general gastroenterologists was not significant.

In a subset of patients with fecal elastase below 200 ug/L, pancreas specialists performed DEXA in 62%, PCPs in 40% and gastroenterologists in 11%, while all patients underwent vitamin D testing.

Sixty-eight percent of the patients in the study who underwent DEXA had low bone-mineral density, the authors note.

"A baseline BMD test by DEXA is recommended in most patients with significant inflammatory or malabsorptive diseases and repeated every 2 years," they add. "This should also be extended to patients with chronic pancreatitis, specifically in patients with additional risk such as postmenopausal women, those with previous low-trauma fractures, men over 50 years, and those with malabsorption."

They add: "The variation in this study among different providers can be explained by the absence of clear established guidelines for bone health surveillance. A collaborative approach may be beneficial in the treatment of this cohort of patients."

"There is insufficient awareness of the high risk of metabolic bone disease in patients with chronic pancreatitis," Dr. McNabb-Baltar said. "The care of patients with chronic pancreatitis is complex and screening is an important part of our job to keep our patients healthy and avoid complications such as bone fractures."

"Further efforts are needed to raise awareness and educate gastroenterologists and primary-care physicians alike about the appropriate care of patients with chronic pancreatitis," she concluded.

SOURCE: Digestive Diseases and Sciences, online August 20, 2020.