Burden of bone disease in chronic pancreatitis:A systematic review and meta-analysis  

作　　者：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 

机构地区：[1]Department of Gastroenterology,Beth Israel Deaconess Medical Center,Boston,MA 02215,United States [2]Department of Medicine,Norwalk Hospital,Yale School of Medicine,Norwalk,CT 06850,United States [3]Cushing/Whitney Medical Library,Yale University,New Haven,CT 06510,United States [4]General Internal Medicine,Yale School of Medicine,New Haven,CT 06510,United States

出　　处：《World Journal of Gastroenterology》2023年第8期1374-1394,共21页世界胃肠病学杂志（英文版）

摘　　要：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 metaanalyzed 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%).Metaregression 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 metaanalysis.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.

关 键 词：Chronic pancreatitis FRACTURES OSTEOPOROSIS OSTEOPENIA Bone disease 

分 类 号：R576[医药卫生—消化系统]