Bone disease in chronic pancreatitis

Patients with chronic pancreatitis have a high risk of developing osteoporosis due to low serum vitamin D levels, poor dietary intake, heavy smoking, low physical activity, chronic inflammation, and malabsorption. Osteoporosis and the resultant low-trauma fractures are associated with a heavy economic burden. Dual X-ray absorptiometry (DXA) is the clinical gold standard and primary diagnostic tool for evaluating osteoporosis. Bone turnover markers determine bone formation and resorption and may have a role in monitoring the effects of treatment. Up to two-thirds of patients with chronic pancreatitis have either osteoporosis or osteopenia, and patients have a high risk of low-trauma fracture—similar or higher than those with other gastrointestinal conditions such as celiac disease, Crohn's disease, post-gastrectomy, and cirrhosis. Clinicians must focus on prevention, and all patients should be counseled on basic preventative measures and should undergo serum vitamin D testing and baseline DXA at diagnosis, repeated every 2 years. Those with osteoporosis should be prescribed therapeutic agents and should ideally be referred to a bone specialist. Research is required on how best to manage osteoporosis in chronic pancreatitis. Ongoing education, awareness campaigns, and promotion of bone health for chronic pancreatitis is vital.