Chronic pancreatitis is associated with metabolic bone disease which increases the risk of fragility fractures. The National Institute of Clinical Excellence (NICE) guidance recommends that all patients aged 50 or over should be considered for DEXA scanning if at risk. Previous data has shown underutilisation of DEXA scanning in this population despite increased risk of osteoporosis. The aim of this study was to assess compliance with metabolic bone assessment in patients with chronic pancreatitis, assess the prevalence of abnormal DEXA scans and the impact of this assessment on appropriate management.Patients and methods
Retrospective analysis of outpatient coding for “chronic pancreatitis” was performed over a 2 year period. Patient demographics, aetiology of chronic pancreatitis, prescription of pancreatic enzyme replacement therapy (PERT), vitamin D levels, DEXA scan result, history of fractures and bone protection medications were noted. Univariate and multivariable analysis were performed to explore why DEXA scanning was not performed as well as factors associated with abnormal scans. The impact of DEXA scanning on prescription of bone protection was also assessed.Results
134 chronic pancreatitis patients (mean age 57.6 years, 88 males) were included with aetiology recorded as alcohol (n=68), idiopathic (n=52), hypertriglyceridaemia (n=5), autoimmune (n=4), hereditary (n=3), anatomical (n=1) and biliary (n=1). 102/134 (76.1%) had vitamin D levels tested of which 82/104 (78.8%) were low. 62/134 (46.3%) had been sent for DEXA scanning of which 8 results were unavailable, 19 (30.6%) were normal, 24 (38.7%) showed osteopenia and 11 (17.7%) osteoporosis. 46/62 (74.2%) who had a DEXA scan were on bone protection compared to 30/72 (41/7%) who did not have a DEXA scan (p=0.002). Lack of DEXA scanning was associated with female sex (adjusted OR 0.22, 95% CI 0.09–0.57, p=0.0017) and not requiring PERT (adjusted OR 0.44, 0.20–0.95, p=0.035). Not requiring PERT was also independently associated (protective) with abnormal DEXA scan results (adjusted OR 0.17, 95% CI 0.03–0.98, p=0.047). 76 patients were prescribed bone protection with a higher proportion in those that had undergone a DEXA scan (46/62 with DEXA vs 30/72 without DEXA, p=0.002). 21/134 (15.7%) had a previous fracture of which 10 had DEXA scanning. 8/10 were on bone protection compared to 2/11 who had not had aResults
DEXA scan (p=0.03).Conclusions
Despite a high prevalence of metabolic bone disease, less than half of chronic pancreatitis patients were assessed. Not requiring PERT and females were less likely to have a DEXA. Interestingly, DEXA scanning was associated with appropriate prescription of bone protection. Whether a standardised proforma would improve rates of metabolic bone assessments needs to be studied.