Bone Disease in Chronic Pancreatitis: A Complex Phenomenon

Osteoporosis Clinical Trial

Official title:

Bone Disease in Chronic Pancreatitis: A Complex Phenomenon

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02108509
• Other study ID #: 0113-14-FB
• Status: Completed
• Start date: May 5, 2014
• Est. completion date: July 18, 2018

Study information

• Verified date: September 2023
• Source: University of Nebraska
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

The purpose of this study is to define the prevalence of low bone density (osteopenia/osteoporosis) in patients with chronic pancreatitis. Secondary aims include investigating the prevalence of hypogonadism (low sex hormones) in patients with chronic pancreatitis and determining if hypogonadism and/or use of narcotic pain medications are risk factors for low bone density in this patient population.

1. Hypothesis:

Patients with chronic pancreatitis are at increased risk of low bone density (osteopenia/osteoporosis), and hypogonadism (low sex hormone levels) and narcotic pain medication use are independent risk factors for the development of low bone density in this patient population.

2. The outcome measures include:

i) Prevalence of low bone density (osteopenia/osteoporosis) in patients with chronic pancreatitis (as determined by DXA scan and fracture history).

ii) Prevalence of hypogonadism (low sex hormones) in patients with chronic pancreatitis (as determined by sex hormone levels and clinical history).

iii) Identification of hypogonadism and/or opioid use as risk factors for low bone density in patients with chronic pancreatitis (as determined by univariate and multivariate analysis of multiple risk factors).

3. After obtaining written consent from potential subjects, a questionnaire will be performed outlining risk factors for low bone density. Dual X-ray absorptiometry (DXA scan) will be performed to evaluate for low bone density and a blood test will be performed to evaluate for low sex hormones, low levels of vitamin D, and other risk factors for low bone density.

Description:

Chronic pancreatitis is defined as a continuing inflammatory disease of the pancreas characterized by irreversible morphologic changes that typically cause pain and/or permanent loss of function. The annual incidence of chronic pancreatitis in the Unites States is 5-12 per 100,000 and prevalence of 50 per 100,000 persons though the incidence is rising over time . The most common symptoms related to chronic pancreatitis include steatorrhea and abdominal pain. Pain with chronic pancreatitis can be severe and debilitating and opioid pain medications are frequently utilized in the management of these symptoms .

A number of chronic malabsorptive disorders, including Crohn's disease, celiac disease, and cystic fibrosis are known to be associated with decreased bone mineral density. Similarly, there is increasing data supporting low bone mineral density (osteopenia and osteoporosis) in patients with chronic pancreatitis, though the exact mechanisms remain unclear.

A meta-analysis of 11 observational studies of chronic pancreatitis reported the prevalence of osteopenia to be 39.8% and osteoporosis 23.4%, with the cumulative prevalence of low bone density (osteopenia and osteoporosis) being almost 65%. Interestingly, out of the eleven studies in this meta-analysis, eight were performed in Europe, two in India, and one in South America.

Some studies in chronic pancreatitis have described a link between Vitamin D deficiency and risk for low bone density. Other proposed risk factors for low bone density in this patient population include age, gender, malnutrition, alcohol use, smoking, and variation and duration of pancreatitis. However, other potential novel risk factors for low bone density exist in patients with chronic pancreatitis. These factors include chronic use of opioid medications and hypogonadism.

Opioid use is prominent in patients with chronic pancreatitis. At least 85% of patients suffering from chronic pancreatitis will develop pain and despite many different treatment methods, many patients with chronic pancreatitis do not get respite from their pain, even after several years. Therefore, up to 50% or more of all patients with chronic pancreatitis will utilize opioid medications as part of their pain management strategy. Opioid medication use has been shown to be a risk factor for low bone density. The exact mechanism behind opioid-induced low bone density is not known but is likely multi-factorial.

To date, the prevalence of hypogonadism in patients with chronic pancreatitis is unknown but would be expected to be higher than the general population due to the risk factors of opioid use, chronic illness, and potentially malnutrition. This warrants further investigation as a higher prevalence of hypogonadism could directly impact bone health in this cohort, not to mention potential effects of hypogonadism on quality of life and fertility.

This research project will utilize Dual X-ray absorptiometry (DXA scan) and clinical history to determine the prevalence of low bone density (osteopenia/osteoporosis) in our cohort; blood draw, clinical history, and questionnaire to determine prevalence of hypogonadism in our cohort; and blood draw, clinical history, and questionnaire to examine specific risk factors for low bone density in our cohort.

After obtaining written consent from potential subjects, a questionnaire will be performed outlining smoking history, alcohol use history, fracture history, signs/symptoms of hypogonadism, exercise patterns, and opioid medication use history. A one-time Dual X-ray absorptiometry (DXA scan) will be performed on each subject. A one-time blood draw will be performed on each subject, with the following lab tests being performed on each subject:

• 25-hydroxy Vitamin D

• Comprehensive Metabolic Panel

• Total Testosterone (males)

• Estradiol (females)

• Lutenizing hormone (LH)

• Follicle-stimulating hormone (FSH)

• Steroid hormone binding globulin (SHBG)

• Prolactin

Recruitment information / eligibility

• Status: Completed
• Enrollment: 55
• Est. completion date: July 18, 2018
• Est. primary completion date: December 1, 2017
• Accepts healthy volunteers: No
• Gender: All
• Age group: 19 Years to 75 Years

Eligibility

Inclusion Criteria:

• Age 19-75 years

• Diagnosis of Chronic Pancreatitis, as defined by specific clinical criteria

Exclusion Criteria:

• Refusal to complete the consent process in it's entirety.

• Pregnancy

Related Conditions & MeSH terms

• Bone Diseases
• Bone Diseases, Metabolic
• Chronic Pancreatitis
• Osteopenia
• Osteoporosis
• Pancreatitis
• Pancreatitis, Chronic

Locations

Country	Name	City	State
United States	University of Nebraska Medical Center	Omaha	Nebraska

Sponsors (1)

Lead Sponsor	Collaborator
University of Nebraska

Country where clinical trial is conducted

United States, 

References & Publications (23)

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Duggan SN, Smyth ND, Murphy A, Macnaughton D, O'Keefe SJ, Conlon KC. High prevalence of osteoporosis in patients with chronic pancreatitis: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2014 Feb;12(2):219-28. doi: 10.1016/j.cgh.2013.06.016. Epub 2013 Jul 12. — View Citation

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Haaber AB, Rosenfalck AM, Hansen B, Hilsted J, Larsen S. Bone mineral metabolism, bone mineral density, and body composition in patients with chronic pancreatitis and pancreatic exocrine insufficiency. Int J Pancreatol. 2000 Feb;27(1):21-7. doi: 10.1385/IJGC:27:1:21. — View Citation

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Joshi A, Reddy SV, Bhatia V, Choudhuri G, Singh RK, Singh N, Bhatia E. High prevalence of low bone mineral density in patients with tropical calcific pancreatitis. Pancreas. 2011 Jul;40(5):762-7. doi: 10.1097/MPA.0b013e31821396b2. — View Citation

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Li L, Setoguchi S, Cabral H, Jick S. Opioid use for noncancer pain and risk of fracture in adults: a nested case-control study using the general practice research database. Am J Epidemiol. 2013 Aug 15;178(4):559-69. doi: 10.1093/aje/kwt013. Epub 2013 May 2. — View Citation

Mann ST, Stracke H, Lange U, Klor HU, Teichmann J. Vitamin D3 in patients with various grades of chronic pancreatitis, according to morphological and functional criteria of the pancreas. Dig Dis Sci. 2003 Mar;48(3):533-8. doi: 10.1023/a:1022540816990. — View Citation

Nusrat S, Yadav D, Bielefeldt K. Pain and opioid use in chronic pancreatitis. Pancreas. 2012 Mar;41(2):264-70. doi: 10.1097/MPA.0b013e318224056f. — View Citation

Sikkens EC, Cahen DL, Koch AD, Braat H, Poley JW, Kuipers EJ, Bruno MJ. The prevalence of fat-soluble vitamin deficiencies and a decreased bone mass in patients with chronic pancreatitis. Pancreatology. 2013 May-Jun;13(3):238-42. doi: 10.1016/j.pan.2013.02.008. Epub 2013 Mar 4. — View Citation

Smith HS, Elliott JA. Opioid-induced androgen deficiency (OPIAD). Pain Physician. 2012 Jul;15(3 Suppl):ES145-56. — View Citation

Sudeep K, Chacko A, Thomas N, Selvakumar R, George B, Paul TV, Seshadri MS. Predictors of osteodystrophy in patients with chronic nonalcoholic pancreatitis with or without diabetes. Endocr Pract. 2011 Nov-Dec;17(6):897-905. doi: 10.4158/EP10410.OR. — View Citation

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Teichmann J, Mann ST, Stracke H, Lange U, Hardt PD, Klor HU, Bretzel RG. Alterations of vitamin D3 metabolism in young women with various grades of chronic pancreatitis. Eur J Med Res. 2007 Aug 16;12(8):347-50. — View Citation

Tignor AS, Wu BU, Whitlock TL, Lopez R, Repas K, Banks PA, Conwell D. High prevalence of low-trauma fracture in chronic pancreatitis. Am J Gastroenterol. 2010 Dec;105(12):2680-6. doi: 10.1038/ajg.2010.325. Epub 2010 Aug 24. — View Citation

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* Note: There are 23 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	To define the prevalence of low bone density (osteopenia or osteoporosis) in patients with chronic pancreatitis	Our hypothesis is that there is a high prevalence of low bone density in patients with chronic pancreatitis. We will measure bone density with a bone density (DXA) scan and also obtain fracture history to determine the prevalence of low bone density.	Single time point (at time of data collection)
Secondary	Prevalence of hypogonadism in patients with chronic pancreatitis.	We hypothesize that the prevalence of hypogonadism will be higher than the general population in patients with chronic pancreatitis. We will utilize clinical history and measurements of sex hormones (testosterone for men, estradiol for women) to determine the prevalence of hypogonadism in this patient population.	Single time point (at time of data collection)
Secondary	Hypogonadism and/or opioid medication use are independent risk factors for low bone density in patients with chronic pancreatitis.	We hypothesize that hypogonadism and opioid medication use are independent risk factors for low bone density in patients with chronic pancreatitis. We will utilize clinical history and serum hormone levels to define subjects with hypogonadism, and obtain detailed medication lists to define opioid medication use for each subject. This information will be analyzed along with other variables to determine if hypogonadism and/or opioid use are independently associated with low bone density.	Single time point (at time of data collection)