Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2023; 29(8): 1374-1394
Published online Feb 28, 2023. doi: 10.3748/wjg.v29.i8.1374
Burden of bone disease in chronic pancreatitis: A systematic review and meta-analysis
Ankit Chhoda, Maria Jose Hernandez-Woodbine, Nana Afua Akkya Addo, Syed Alishan Nasir, Alyssa Grimshaw, Craig Gunderson, Awais Ahmed, Steven D. Freedman, Sunil G. Sheth
Ankit Chhoda, Maria Jose Hernandez-Woodbine, Awais Ahmed, Steven D. Freedman, Sunil G. Sheth, Department of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
Nana Afua Akkya Addo, Syed Alishan Nasir, Department of Medicine, Norwalk Hospital, Yale School of Medicine, Norwalk, CT 06850, United States
Alyssa Grimshaw, Cushing/Whitney Medical Library, Yale University, New Haven, CT 06510, United States
Craig Gunderson, General Internal Medicine, Yale School of Medicine, New Haven, CT 06510, United States
Author contributions: Sheth SG and Chhoda A contributed to the study conception; Chhoda A, Addo NAA, and Hernandez-Woodbine MJ contributed to the study selection; Chhoda A and Hernandez-Woodbine MJ contributed to the data acquisition, analysis, and manuscript drafting; Grimshaw A contributed to the study accrual; Gunderson C contributed to the statistical supervision; Chhoda A and Nasir SA contributed to the study quality assessment; Ahmed A, Freedman SD, and Sheth SG contributed to the manuscript edition.
Conflict-of-interest statement: All the authors have no personal, financial or professional conflict of interest disclosures to declare.
PRISMA 2009 Checklist statement: The authors have read PRISMA checklist and revised according to PRISMA checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https: //creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sunil G. Sheth, AGAF, FACG, FASGE, MBBS, MD, Associate Professor, Department of Gastroenterology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States. ssheth@bidmc.havard.edu
Received: November 12, 2022
Peer-review started: November 12, 2022
First decision: January 2, 2023
Revised: January 15, 2023
Accepted: February 15, 2023
Article in press: February 15, 2023
Published online: February 28, 2023
Processing time: 107 Days and 18.8 Hours
Abstract
BACKGROUND

Bone disease is an under-recognized cause of morbidity in chronic pancreatitis (CP). Over the past decade, publications of original studies on bone disease in CP has warranted synthesis of the evidence to ascertain the true burden of the problem.

AIM

To quantify the prevalence of osteopenia, osteoporosis, and fragility fractures in CP patients and investigate the associated clinical features and outcomes.

METHODS

A systematic search identified studies investigating bone disease in CP patients from Cochrane Library, Embase, Google Scholar, Ovid Medline, PubMed, Scopus, and Web of Science, from inception until October 2022. The outcomes included prevalence of osteopenia, osteoporosis, and fragility fractures, which were meta-analyzed using a random-effects model and underwent metaregression to delineate association with baseline clinical features.

RESULTS

Twenty-one studies were included for systematic review and 18 studies were included for meta-analysis. The pooled prevalence of osteopenia and osteoporosis in CP patients was 41.2% (95%CI: 35.2%-47.3%) and 20.9% (95%CI: 14.9%-27.6%), respectively. The pooled prevalence of fragility fractures described among CP was 5.9% (95%CI: 3.9%-8.4%). Meta-regression revealed significant association of pancreatic enzyme replacement therapy (PERT) use with prevalence of osteoporosis [coefficient: 1.7 (95%CI: 0.6-2.8); P < 0.0001]. We observed no associations with mean age, sex distribution, body mass index, alcohol or smoking exposure, diabetes with prevalence of osteopenia, osteoporosis or fragility fractures. Paucity of data on systemic inflammation, CP severity, and bone mineralization parameters precluded a formal meta-analysis.

CONCLUSION

This meta-analysis confirms significant bone disease in patients with CP. Other than PERT use, we observed no patient or study-specific factor to be significantly associated with CP-related bone disease. Further studies are needed to identify confounders, at-risk population, and to understand the mechanisms of CP-related bone disease and the implications of treatment response.

Keywords: Chronic pancreatitis; Fractures; Osteoporosis; Osteopenia; Bone disease

Core Tip: Bone disease is an under recognized cause of morbidity in chronic pancreatitis (CP). This systematic review and meta-analysis demonstrate substantial burden of bone disease (osteopenia and osteoporosis) and fragility fractures in CP patients. In addition, metaregression has demonstrated a significant association of osteoporosis with pancreatic enzyme replacement. The study is powered by high-quality studies with large sample size and clearly defined study population and outcome measures.