Sinead N Duggan1, Christina Purcell1, Mark Kilbane2, Myra O'Keane2, Malachi McKenna2, Peter Gaffney3, Paul F Ridgway1, Gerard Boran3, Kevin C Conlon4. 1. Professorial Surgical Unit, Trinity Centre for Health Sciences, Tallaght Hospital, Trinity College Dublin, Dublin, Ireland. 2. Metabolism Laboratory, St Vincent's University Hospital, Dublin, Ireland. 3. Department of Biochemistry, Tallaght Hospital, Dublin, Ireland. 4. Professorial Surgical Unit, Tallaght Hospital, St Vincent's University Hospital Dublin, Trinity College Dublin, Dublin, Ireland.
Abstract
INTRODUCTION: Because of deteriorating exocrine function, malabsorption renders chronic pancreatitis (CP) patients at risk of osteoporosis and fracture. However, the pathogenesis of low bone mineral density (BMD) has not been characterized. We hypothesized that bone turnover is elevated in CP, and we sought to investigate an association between bone metabolism and systemic inflammation. METHODS: Twenty-nine CP patients and twenty-nine matched controls were recruited. Bone-turnover markers procollagen 1 amino-terminal propeptide (P1NP), OC (osteocalcin; bone formation markers), and carboxy-terminal telopeptide of type I collagen (CTX-I; bone resorption marker) were measured along with vitamin D (25-hydroxyvitamin D, 25OHD), parathyroid hormone (PTH), interleukin 6 (IL-6), high-sensitivity (hs) C-reactive protein (CRP), and sex/thyroid hormones. BMD was measured by dual-energy X-ray absorptiometry. Smoking status was noted. RESULTS: Of the CP patients, 31% had osteoporosis and 44.8% osteopenia (controls: 6.9 and 51.7%, respectively; P=0.019). BMD was lower for patients at the lumbar spine (P=0.014) and femoral neck (P=0.029). Patients had elevated bone formation (P1NP (P=0.0068), OC (P=0.033)) and bone resportion (CTX-I (P=0.016)) compared with controls. Patients had lower 25OHD compared with controls (P=0.0126) and higher inflammatory markers (hsCRP, P=0.0013). Sex and thyroid hormone levels were similar. Patients with lowest 25OHD levels had highest P1NP. In a multivariable model, age, PTH, and smoking were predictive of 25OHD. Patients with osteoporosis had higher P1NP, PTH, and IL-6 and lower 25OHD. Using analysis of variance, inflammation (hsCRP) was highest in those with lowest 25OHD and lowest BMD. CONCLUSIONS: For the first time, bone turnover was shown to be abnormal in CP, and importantly, an association between low 25-OHD, smoking, and systematic inflammation was identified. Moreover, those with osteoporosis had the highest systemic inflammation. Together these factors provide an avenue for potential modification of risk factors, which may ultimately reduce bone loss and avert fractures in this group.
INTRODUCTION: Because of deteriorating exocrine function, malabsorption renders chronic pancreatitis (CP) patients at risk of osteoporosis and fracture. However, the pathogenesis of low bone mineral density (BMD) has not been characterized. We hypothesized that bone turnover is elevated in CP, and we sought to investigate an association between bone metabolism and systemic inflammation. METHODS: Twenty-nine CP patients and twenty-nine matched controls were recruited. Bone-turnover markers procollagen 1 amino-terminal propeptide (P1NP), OC (osteocalcin; bone formation markers), and carboxy-terminal telopeptide of type I collagen (CTX-I; bone resorption marker) were measured along with vitamin D (25-hydroxyvitamin D, 25OHD), parathyroid hormone (PTH), interleukin 6 (IL-6), high-sensitivity (hs) C-reactive protein (CRP), and sex/thyroid hormones. BMD was measured by dual-energy X-ray absorptiometry. Smoking status was noted. RESULTS: Of the CP patients, 31% had osteoporosis and 44.8% osteopenia (controls: 6.9 and 51.7%, respectively; P=0.019). BMD was lower for patients at the lumbar spine (P=0.014) and femoral neck (P=0.029). Patients had elevated bone formation (P1NP (P=0.0068), OC (P=0.033)) and bone resportion (CTX-I (P=0.016)) compared with controls. Patients had lower 25OHD compared with controls (P=0.0126) and higher inflammatory markers (hsCRP, P=0.0013). Sex and thyroid hormone levels were similar. Patients with lowest 25OHD levels had highest P1NP. In a multivariable model, age, PTH, and smoking were predictive of 25OHD. Patients with osteoporosis had higher P1NP, PTH, and IL-6 and lower 25OHD. Using analysis of variance, inflammation (hsCRP) was highest in those with lowest 25OHD and lowest BMD. CONCLUSIONS: For the first time, bone turnover was shown to be abnormal in CP, and importantly, an association between low 25-OHD, smoking, and systematic inflammation was identified. Moreover, those with osteoporosis had the highest systemic inflammation. Together these factors provide an avenue for potential modification of risk factors, which may ultimately reduce bone loss and avert fractures in this group.
Authors: Russel Burge; Bess Dawson-Hughes; Daniel H Solomon; John B Wong; Alison King; Anna Tosteson Journal: J Bone Miner Res Date: 2007-03 Impact factor: 6.741
Authors: Georg Schett; Stefan Kiechl; Siegfried Weger; Angelo Pederiva; Agnes Mayr; Manuele Petrangeli; Friedrich Oberhollenzer; Rolando Lorenzini; Kurt Redlich; Roland Axmann; Jochen Zwerina; Johann Willeit Journal: Arch Intern Med Date: 2006 Dec 11-25
Authors: Samuel Vasikaran; Cyrus Cooper; Richard Eastell; Andrea Griesmacher; Howard A Morris; Tommaso Trenti; John A Kanis Journal: Clin Chem Lab Med Date: 2011-05-24 Impact factor: 3.694
Authors: Sinead N Duggan; Hazel M Ní Chonchubhair; Oladapo Lawal; Donal B O'Connor; Kevin C Conlon Journal: World J Gastroenterol Date: 2016-02-21 Impact factor: 5.742
Authors: Hannah M Komar; Phil A Hart; Zobeida Cruz-Monserrate; Darwin L Conwell; Gregory B Lesinski Journal: Pancreas Date: 2017-09 Impact factor: 3.327
Authors: Jillian K Wothe; Robert Aidoo; Kendall R McEachron; Tasma Harindhanavudhi; Guru Trikudanathan; Martin L Freeman; Varvara Kirchner; Timothy L Pruett; Gregory J Beilman; James S Hodges; Melena D Bellin Journal: Pancreatology Date: 2021-09-04 Impact factor: 3.996
Authors: Julia B Greer; Phil Greer; Bimaljit S Sandhu; Samer Alkaade; C Mel Wilcox; Michelle A Anderson; Stuart Sherman; Timothy B Gardner; Michele D Lewis; Nalini M Guda; Thiruvengadam Muniraj; Darwin Conwell; Gregory A Cote; Christopher E Forsmark; Peter A Banks; Gong Tang; Kim Stello; Andres Gelrud; Randall E Brand; Adam Slivka; David C Whitcomb; Dhiraj Yadav Journal: Nutr Clin Pract Date: 2018-08-13 Impact factor: 3.080