The Impact of Exocrine Pancreatic Insufficiency in Patients with Chronic Pancreatitis on Bone Health - a Literature Review

Background. Chronic pancreatitis is described as irreversible damage to the pancreas leading to endocrine and exocrine dysfunction. Exocrine pancreatic insufficiency (EPI) results in maldigestion and malabsorption of nutrients that is associated with developing osteopenia and osteoporosis that elevates bone fragility and puts patients at higher risk of higher low fracture rates. Aim. This review aims to outline current evidence on the pathophysiological mechanism, prevalence, risk factors and clinical implications of osteoporosis in patients with EPI secondary to chronic pancreatitis. Material and methods. A comprehensive literature search was performed using electronic databases (including PubMed, Web of Science, and ClinicalKey), to identify studies examining osteoporosis in patients with chronic pancreatitis. Searches were performed using relevant keywords and combinations such as “chronic pancreatitis,” “exocrine pancreatic insufficiency,” “osteoporosis,” “osteopenia,” and “bone mineral density.” Studies published in English were considered. Manual screening of references from all included studies was performed to locate further relevant studies Extracted data were synthesized qualitatively using a literature review approach, focusing on prevalence, risk factors, pathophysiology, and clinical outcomes related to bone health in this population. Conclusion. Patients with chronic pancreatitis and long-term exocrine pancreatic insufficiency frequently display reduced bone mineral density, resulting in increased osteoporosis risk and fragility fractures. Enzyme therapy should be provided to improve nutrient absorption. Further research is needed to precisely determine fracture-related morbidity and mortality in this population.