Chronic pancreatitis and the skeleton

Czech version

Authors: H. Dujsíková ¹; I. Novotný ¹; J. Tomandl ²; Petr Dítě ¹
Authors‘ workplace: Interní hepatogastroenterologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jan Lata, CSc. ¹; Ústav klinické biochemie Lékařské fakulty MU Brno, přednostka prof. RNDr. Eva Táborská, CSc. ²
Published in: Vnitř Lék 2010; 56(7): 656-662
Category: 80th Birthday - Jaroslava Blahoše, MD, DrSc.

Overview

The aim of our work was to determine the incidence of bone demineralization in patients with chronic pancreatitis, following the relation between the funcionality of the pancreatic tissue and etiological factors in the development of osteopathy and calciophosphate metabolism. Prospectivelly, during 1 year we followed 55 patients with chronic pancreatitis of different etiology verified by endoultrasound. Patients with other possible cause of osteopathy were not included in the group. In the following of calciophosphate metabolism we determined different biochemical parameters and we measured the bone mass with densitometry in standard locations. In the patients that we followed we managed to show high proportion (43.7 %) of bone demineralization, however, no relation between the bone demineralization and the grade of chronic pancreatitis or the operation of pancreas was proved. Vitamin D deficiency has a significantly negative impact on bone metabolism, which is potentiated by pancreatic insufficiency and long‑time alcohol abuse.

Key words:
chronic pancreatitis – osteopenia – osteoporosis – pancreatitic insufficiency – toxonutritive etiology – idiopatic etiology

Sources

1. Sarles H, Adler Q, Dani R et al. Classification of pancreatitis and definition of pancreatic disease. Digestion 1989; 43: 234–236.

2. Sarles H, Bernard JP, Johnson C. Pathogenesis and epidemiology of chronic pancreatitis. Ann Rev Med 1989; 40: 453–468.

3. WHO Study Group: Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO Technical Reports Series 843, Geneva, World Health Organization 1994.

4. Favus MJ. Primer on the metabolic bone diseases and disorders of mineral metabolism. Philadelphia – New York, Lippencott – Raven Publishers 1996, 477.

5. Haaber AB, Rosenfalck AM, Hansen B et al. Bone Mineral Metabolism, Bone Mineral Density, and Bone Composition in Patients with Chronic Pancreatitis and Pancreatic Exocrine Insufficiency. International Journal of Pancreatology 2000; 27: 21–27.

6. Morán CE, Sosa EG, Martinez SM et al. Bone Mineral Density in Patients with Pancreatic Insufficiency and Steatorrhea. The American Journal of Gastroenterology 1997; 92: 867–871.

7. Sarner M, Cotton PB: Classification of pancreatitis. Gut 1984; 25: 756–759.

8. Wiersema MJ, Hawes RH, Lehman GA et al. Prospective Evaluation of Endoscopic Ultrasonography and Endoskopic Retrograde Cholangiopancreatography in Patients with Chronic Abdominal Pain of Suspected Pancreatic Origin. Endoscopy 1993; 25: 555–564.

9. Teichmann J, Mann STW, Stracke H et al. Alterations of Vitamin D3 Metabolism in Young Women with Various Grades of Chronic Pancreatitis. European Journal of Medical Research 2007; 12: 347–350.

10. Mann STW, Stracke H, Lange U et al. Vitamin D3 in Patients with Various Grades of Chronic Pancreatitis, According to Morphological and Functional Criteria of the Pancreas. Digestive Diseases and Sciences 2003; 48: 533–538.

11. Mann STW, Stracke H, Lange U et al. Alterations of Bone Mineral Density and Bone Metabolism in Patients With Various Grades of Chronic Pancreatitis. Metabolism 2003; 52: 579–585.

12. Mehaut M, Maudiére R. Fréquence et signification des fractures de notes chez l’alcoolique. Arch Mal App Dig 1967; 56: 901.

13. Saville PD. Changes in bone mass with age and alcoholism. J Bone Joint Surg 1965; 47A: 492–499.

14. Vodoz JF, Luisier M, Donath A. Diminution de l’absorption intestinale de 47-Calcium dans l’alcoolisme chronique. Schweiz Med Wochenschr 1977; 107: 1525–1529.

15. Lalor BC, France MW, Powell D. Bone and mineral metabolism and chronic alcohol abusus. Quart J Med 1986; 59: 497–511.

16. Dalén N, Feldrich AZ. Osteopenia in alkoholism. Clin Orthop Rel Res 1974; 20: 201–202.