Introduction Chronic pancreatitis is a common condition managed in the outpatient setting. One of the common complications is osteoporosis and patients have double the risk of fragility fractures compared with the general population. The National Institute of Clinical Excellence (NICE) guidance recognises chronic pancreatitis as a significant risk factor and recommends that all patients aged 50 or over should be considered for DEXA scanning if they are deemed at risk.1 The purpose of this study was to assess whether patients under review for chronic pancreatitis were being referred for DEXA scanning and to pick up the rate of fragility fractures.
Methods A Single Centre, retrospective analysis of all patients identified coded as having “chronic pancreatitis” under ongoing outpatient review in a large NHS Hospital Trust in North London. We reviewed their records and imaging to assess if they had ever been referred for a DEXA scan and whether they had radiological evidence of a fragility fracture whilst under review for pancreatitis.
Results Of 106 patients identified, only 1 (0.94%) was referred for DEXA scanning, which did confirm osteoporosis. This patient had been referred incidentally by a GP for another reason not pertaining to their chronic pancreatitis. 14 patients (13.21%) had sustained low impact fractures (5 hip, 3 vertebral, 3 wrist, 2 distal fibula, 1 elbow). Of these fractures 6 (42.9%) had been on no bone protection at all, 6 (42.9%) had been on calcium and vitamin D supplementation, and 2 (14.3%) had been on a bisphosphonate.
Conclusion Despite chronic pancreatitis being a well-recognised risk factor for osteoporosis, the investigation and active mitigation of its risk by clinicians in the outpatient setting was poor. This may have resulted in potentially avoidable osteoporotic fractures and future studies should look at whether this is a wider phenomena nationally. We would recommend that risk assessment for osteoporosis should form a part of a routine clinical review in patients under follow up for chronic pancreatitis.
Reference 1 NICE. Osteroporosis: assessing the risk of fragility fracture. NICE guidelines CG146. August 2012.
Disclosure of Interest None Declared