Vitamins D and K as Factors Associated with Osteopathy in Chronic Pancreatitis: A Prospective Multicentre Study (P-BONE Study)

Abstract

BackgroundOsteopathy is common in patients with chronic pancreatitis (CP), but previous studies carry several limitations. Vitamin K is essential for bone metabolism, but its role in this setting has never been investigated. Our aim is to assess the prevalence of osteoporosis and osteopenia in CP patients, and to investigate the association between osteopathy and CP features and nutritional parameters, especially vitamin D and K levels.MethodsMulticentre cross-sectional study on CP patients diagnosed according to M-ANNHEIM criteria. Bone density was evaluated by dual-energy X-ray absorptiometry and pancreatic function by faecal elastase. Nutritional evaluation included vitamin D and vitamin K. Differences between patients with or without osteopathy were evaluated. The association between investigated variables and bone density were analysed with logistic regression analysis.ResultsIn total, 211 CP patients were enrolled at eight Centres (67% men; mean age 60). In total, 18% had advanced-marked CP, 56% suffered from pancreatic exocrine insufficiency and disease aetiology was alcoholic in 43%. Vitamin D and K were deficient in 56% and 32%, respectively. Osteopenia was diagnosed in 42% and osteoporosis in 22%. In the multivariate analysis, female sex (OR 2.78), age (OR 1.07 per year) and higher BMI (OR 0.84) were associated with the presence of osteoporosis. In male patients, the only factor associated with osteoporosis was vitamin K deficiency (OR 4.23).ConclusionThe present data confirm a high rate of osteopathy in CP patients and highlight the relevance of vitamin K deficiency as only factor associated with osteoporosis in male patients for the first time.

<p>Exocrine pancreatic insufficiency: prevalence, diagnosis, and management</p>

“…CP is probably the pancreatic pathology in which EPI is more frequently diagnosed in clinical practice. In this view, the shift toward diagnosis of CP at earlier stages might be an opportunity to diagnose EPI and start PERT before significant complications have occurred 4–6…”

“…EPI can result in clinical manifestation such as steatorrhea, weight loss, and biochemical alterations related to lipids and liposoluble micronutrients malabsorption and maldigestion 1,2. While overt maldigestion is associated with easily detectable symptoms, impairment of quality of life3 and risk of significant complications due to malnutrition such as changes in bone density,4 EPI is also associated with an increased risk of mortality in patients with chronic pancreatitis (CP) due to cancer, infections, and cardiovascular events 5. Less-severe degrees of EPI cause subclinical consequences that might also result important for the nutritional status of patients 6.…”

Malnutrition in Chronic Pancreatitis: Causes, Assessment Methods, and Therapeutic Management

“…One of the most common complications of malnutrition in patients with CP is progressive osteoporosis. This phenomenon was not well understood, so a multicenter study was carried out to recruit patients from several countries [ 24 ]. Osteopenia was found in 40% of patients and osteoporosis in 25%, in all these patients the BMI was lower than that in the remaining patients with CP.…”

Conservative Treatment of Chronic Pancreatitis: A Practical Approach

“…Particularly osteopenia or osteoporosis should be ruled out in all patients with severe insufficiency, through the execution of a dual-energy X-ray absorptiometry (DEXA) (36). From a clinical perspective, symptoms of PEI are consistent with generalized abdominal bloating, flatulence, pain, steatorrhea.…”