High prevalence of low-trauma fracture in chronic pancreatitis

OBJECTIVES:Chronic pancreatitis (CP) is associated with risk factors that may negatively impact bone and mineral metabolism. The important clinical end point of osteoporosis is low-trauma fracture. The purpose of this study was to examine the prevalence of low-trauma fracture in patients with CP, compared with fracture rates in high-risk gastrointestinal (GI) illnesses, for which metabolic bone disease screening guidelines are in place.METHODS:This is a retrospective cohort database study examining patients with CP and high-risk GI illnesses seen at a single tertiary care center. Time points ranged between 31 July 1998 and 31 July 2008. The main outcome measure was low-trauma fracture prevalence using specific International Classification of Diseases, Ninth Revision, Clinical Modification fracture codes.RESULTS:A total of 3,192 CP patients and 1,461,207 non-CP patients were included in the study. The fracture prevalence (patients with fracture per total patients) was as follows: controls, 1.1% (16,208/1,436,699); Crohn's disease, 3.0% (182/6057); CP, 4.8% (154/3192); cirrhosis, 4.8% (805/16,658); celiac disease, 5.0% (74/1480); and postgastrectomy, 5.4% (17/313). Prevalence for each group was statistically greater than controls (P<0.001). CP fracture prevalence was greater than controls (P<0.001) and Crohn's disease (P<0.001), and comparable with the remaining high-risk GI illness groups (P>0.05). The odds of fracture (odds ratio (OR), 95% confidence interval (CI)) compared with controls, adjusted for age, gender, and race was: CP 2.4 (2.1, 2.9); Crohn's disease 1.7 (1.5, 2.0); gastrectomy 2.5 (1.5, 4.1); cirrhosis 2.6 (2.4, 2.7); and celiac disease 2.7 (2.1, 3.4). The odds of fracture for each disease group were statistically greater than controls (P<0.0001).CONCLUSIONS:The prevalence of low-trauma fracture in CP patients is comparable with or higher than that of high-risk GI illnesses, for which osteoporosis screening guidelines exist.