Остеопороз у пацієнтів із хронічним панкреатитом – особливості діагностики

Abstract

The purpose of the study was to determine the features of the development of osteoporotic bone changes in patients with fibrotic changes of the pancreas against the background of chronic pancreatitis. Materials and methods. 55 patients with chronic pancreatitis were examined. 30 examined were women, 25 were men. The average age of the patients was 47.3±3.5 years. To be included in the study, all patients were excluded from the presence of concomitant diseases. For female patients, preservation of menstrual function was a mandatory condition for inclusion in the study. The degree of fibrotic changes of the pancreas was established on the basis of conducting 2D shear wave elastometry with transcutaneous access by the shear wave method in the SWE mode. Determination of bone mineral density was carried out using a DEXXUM T X-ray densitometer by the method of dual-energy absorptiometry. Results and discussion. The severity of fibrotic changes in the pancreatic parenchyma also affected the prevalence of osteoporosis and osteopenia. Among patients with parenchyma density indicators corresponding to grade 3-4 of fibrotic changes, a decrease in bone mineral density was observed in 83% of examined patients, while among patients with grade 1-2 of such changes, osteoporosis and osteopenia were found in 34% (p = 0.003). In patients with fibrotic changes in the parenchyma of the pancreas, osteoporotic changes in the area of the lumbar vertebrae were noted in 55% of cases with reduced bone mineral density, an isolated decrease in the mineral density of the lumbar spine was diagnosed in 11 patients (28.2% of patients with a decrease in bone mineral density), 5 patients (12.8%) had a combination of a decrease in the mineral density of the spine with a decrease in the mineral density of the hip, the average T criterion of the vertebrae was -2.4±0.5, the average T criterion of the femoral neck was -2.6±0.36. In patients with fibrosis of the parenchyma of the pancreas of 1-2 stages bone mineral density decreased mainly to the level of osteopenia, with a combination of osteopenic changes in the lumbar spine and a decrease in hip mineral density. The average T criterion of vertebrae was -1.6±0.15, femoral neck -1.76±0.18 Conclusion. Patients with chronic pancreatitis are characterized by a high prevalence of osteoporosis and osteopenia. Patients with stages 3-4 of pancreatic fibrosis have a greater risk of developing this complication. The reduction of bone mineral density in patients with chronic pancreatitis is influenced not only by population risk factors, but also by the duration of pancreatitis. The severity of fibrotic changes in the pancreas affects the localization of changes in bone tissue