Association between pancreatic ectopic fat deposition and QCT-assessed bone mass status in patients with chronic kidney disease: a cross-sectional study

Patients with chronic kidney disease (CKD) are at increased risk of bone abnormalities. Beyond disturbances in mineral metabolism, ectopic fat deposition may also be associated with skeletal abnormalities in CKD. However, the relationship between pancreatic fat and bone mass status remains unclear. This study aimed to evaluate the association between mean pancreatic fat fraction and quantitative computed tomography (QCT)-assessed bone mass status in patients with CKD. This retrospective cross-sectional study included 327 patients with CKD. Vertebral volumetric bone mineral density was measured using QCT to classify bone mass status as normal bone mass, osteopenia, or osteoporosis. Mean pancreatic fat fraction was quantified from CT images. Ordinal logistic regression, restricted cubic spline (RCS), subgroup analyses, and sensitivity analyses were performed to evaluate its association with bone mass status. Mean pancreatic fat fraction was highest in patients with osteoporosis (p < 0.001). In the fully adjusted model, each 5-percentage-point increase in mean pancreatic fat fraction was associated with higher odds of a more severe bone mass category (OR = 1.481, 95% CI: 1.152–1.905, p = 0.002). RCS analysis showed a significant overall association (p = 0.009), with no evidence of nonlinearity (p = 0.290). No statistically significant interactions were detected for sex, age, diabetes status, or CKD stage. A higher mean pancreatic fat fraction was associated with more severe bone mass categories in patients with CKD after adjustment for the measured covariates. QCT-based pancreatic fat assessment may provide additional information on metabolic features associated with bone mass abnormalities in CKD.