title: High prevalence of low-trauma fracture in chronic pancreatitis.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Gastroenterology, Hepatology, and Endoscopy, Center for Pancreatic Disease, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. atignor@partners.org
authors.forename: April S
authors.initials: AS
authors.lastname: Tignor
authors.forename: Bechien U
authors.initials: BU
authors.lastname: Wu
authors.forename: Tom L
authors.initials: TL
authors.lastname: Whitlock
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.forename: Kathryn
authors.initials: K
authors.lastname: Repas
authors.forename: Peter A
authors.initials: PA
authors.lastname: Banks
authors.forename: Darwin
authors.initials: D
authors.lastname: Conwell
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology*; D005598:Fractures, Spontaneous / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology* / Q000209:etiology*; D050500:Pancreatitis, Chronic / Q000150:complications*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors