Send to

Choose Destination
JOP. 2015 Jan 31;16(1):58-62. doi: 10.6092/1590-8577/2898.

Altered bone metabolism and bone density in patients with chronic pancreatitis and pancreatic exocrine insufficiency.

Author information

Gastrocentrum, Karolinska Institutet and University Hospital. Stockholm, Sweden. Department of Medicine II, Medical Faculty Mannheim, University of Heidelberg. Heidelberg, Germany.



Due to maldigestion, pancreatic exocrine insufficiency (PEI) in chronic pancreatitis may lead to deficiencies in fat-soluble vitamins, including vitamin D. This may, in turn, can cause disturbances in bone metabolism and reduce bone mineral density.


To conduct a prospective study of maldigestion, bone metabolism, and bone mineral density in a group of patients with chronic pancreatitis.


A total of 50 male patients with proven chronic pancreatitis (36/50 alcohol; 42/50 smokers) were studied. Pancreatic exocrine function was assessed using the fecal elastase-1 test. Blood and urine samples were analyzed for parameters related to pancreatitis, nutrition, endocrine status, and bone metabolism. Bone mineral density was measured with dual-energy X-ray absorption (DXA) and conventional vertebral X-rays. A standardized questionnaire for osteoporosis was given.


Twenty-eight of the patients had PEI (fecal elastase-1 <200 µg/g), 25 had bone pain, and 21 had a history of bone fractures. Serum 25-OH-cholecalciferol and urine calcium were decreased and deoxypyridinoline concentrations were increased in urine. Serum calcium, bone-specific alkaline phosphatase, and parathyroid hormone were within normal limits. There was no statistical correlation between three classes of fecal elastase-1 (<100 µg/g; 100-200 µg/g; >200 µg/g) and calcium, 25-OH-cholecalciferol, or deoxypyridinoline. Of the 15 patients who underwent DXA, 5 had normal bone mineral density (T score >-1), 9 had osteopenia (T score from -1 to - 2.5), and 1 had osteoporosis (T score <-2.5). There was a trend toward a correlation between low fecal elastase-1 and low T scores (P=0.065). Low fecal elastase-1 correlated with low bone mineral density in conventional X-rays (P<0.05). Patients receiving pancreatic enzyme replacement therapy (PERT) had significantly higher DXA values (P<0.05).


Patients with chronic pancreatitis have osteoporosis, along with abnormal bone metabolism and reduced bone mineral density as measured by DXA and X-ray. PERT is associated with less osteopathy.

Free full text

Supplemental Content

Full text links

Icon for JOP. Journal of the Pancreas (Online)
Loading ...
Support Center