Bone health assessment in clinical practice is infrequenty performed in patients with chronic pancreatitis |
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| Affiliation: | 1. Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA;2. Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA;3. Department of Cell Biology and Physiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA;4. Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA;1. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA;2. Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA;1. Internal Medicine, Faculty of Medicine, Cairo University, Egypt;2. Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt;1. Vejle Hospital, Southern Denmark, Odense, Denmark;2. Juliane Marie Centret, Rigshospitalet, Copenhagen, Denmark;3. Centre for Health Economic Research (COHERE), Institute of Public Health, University of Southern Denmark, Odense, Denmark;4. Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark;5. Department of Surgery, Odense University Hospital, Odense, Denmark;1. Yale Center for Pancreatic Disease, Section of Digestive Disease, Yale University, New Haven, Connecticut, USA;2. Department of Medicine, Indiana University, Indianapolis, Indiana, USA;3. Interpace Diagnostics, Pittsburgh, Pennsylvania, USA;4. Division of Digestive and Liver Disease, Department of Medicine, Columbia University Medical Center, New York, New York, USA;1. Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, The Netherlands;2. Department of Pathology, Erasmus MC University Medical Center Rotterdam, The Netherlands;1. Division of Gastroenterology and Hepatology, Mayo Clinic Health System, Eau Claire, WI, USA;2. Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA;3. Universidad Católica de Santiago de Guayaquil, Guayas, Ecuador;4. Division of Gastroenterology and Hepatology, Ohio State Wexner Medical Center, Columbus, OH, USA;5. Institute for Translational Medicine, Medical School, Szentágothai Research Centre, University of Pécs, Pécs, Hungary;6. Centre for Translational Medicine, Department of Medicine, University of Szeged, Szeged, Hungary;7. Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA |
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| Abstract: | BackgroundChronic pancreatitis (CP) patients have a high prevalence of osteoporotic fractures. In addition to prevalence of osteoporotic fractures, we evaluated how often bone health is assessed by dual-energy x-ray absorptiometry (DXA) in clinical practice, and the performance of Fracture Risk Assessment Tool (FRAX®) in predicting fracture risk in CP patients.MethodsMedical records of CP patients age ≥40 years prospectively enrolled in the North American Pancreatitis Study 2 (NAPS2) from the University of Pittsburgh Medical Center from 2000 to 2014 were retrospectively reviewed to gather additional relevant data before, at, and after enrollment until December 2016. We determined if patients underwent DXA, compared their observed prevalence of fractures with published data from two large US studies based on administrative data, and their predicted fracture risk with US population based on FRAX®.ResultsOnly 21% (49/239) patients were evaluated by DXA during their care. The observed cumulative prevalence of fragility fractures in NAPS2 CP patients (9.2%, 95% confidence interval 5.9–13.6) was significantly greater than in controls (1.46% and 2.16%, p ≤ 0.001 for each comparison) and CP patients (4.66%, and 5.13%, p < 0.005 for each comparison) in the two US administrative data studies. The FRAX® 10-year probability of major osteoporotic fracture of ≥20% (5.1% vs. 8.3%, p > 0.05) and for hip fracture of ≥3% (19.6% vs. 18.9%, p > 0.05) in NAPS2 CP patients did not differ from the US population.ConclusionsDespite their high risk of fragility fractures, bone health is infrequently assessed in CP patients. FRAX® may not adequately predict fracture risk in CP patients. |
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| Keywords: | Dual-energy x-ray absorptiometry (DXA) Osteoporosis Fracture Chronic pancreatitis FRAX® BMD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" bone mineral density BMI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" body mass index CP" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" chronic pancreatitis DXA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" dual energy x-ray absorptiometry FRAX®" },{" #name" :" keyword" ," $" :{" id" :" kwrd0080" }," $$" :[{" #name" :" text" ," _" :" Fracture Risk Assessment HF" },{" #name" :" keyword" ," $" :{" id" :" kwrd0090" }," $$" :[{" #name" :" text" ," _" :" hip fracture IQR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0100" }," $$" :[{" #name" :" text" ," _" :" interquartile range MOF" },{" #name" :" keyword" ," $" :{" id" :" kwrd0110" }," $$" :[{" #name" :" text" ," _" :" major osteoporotic fracture NAPS2" },{" #name" :" keyword" ," $" :{" id" :" kwrd0120" }," $$" :[{" #name" :" text" ," _" :" North American Pancreatitis Study NHANES" },{" #name" :" keyword" ," $" :{" id" :" kwrd0130" }," $$" :[{" #name" :" text" ," _" :" National Health and Nutrition Examination Survey |
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