Bone Mineral Density Decline in Long-Term Pancreaticoduodenectomy Survivors: Dynamics and Risk Factors.

BACKGROUND/PURPOSE: The dynamics of bone mineral density (BMD) decrease after pancreaticoduodenectomy in long-term survivors and its risk factors have scarcely been studied.

METHODS

Seventy-nine patients who underwent pancreaticoduodenectomy and survived for > 5 years were included in this study. We measured the mean CT Hounsfield Unit [HU] values of the anterior trabecular portion of the 1st through 4th lumbar vertebral bodies on a single axial CT scan before pancreaticoduodenectomy and at 1, 2, 3, 4, and 5 years postoperatively. The mean HU values for the 1st to 4th lumbar vertebrae were used as the BMD index.

RESULTS

The percentage annual BMD index decrease after pancreaticoduodenectomy was as follows: before pancreaticoduodenectomy and 1st year postoperatively, 18.9% (p < 0.001); 1-2 years postoperatively, 3.9% (p = 0.014); and 4-5 years postoperatively, 3.9% (p = 0.030). A multivariate analysis revealed that the presence of preoperative obstructive jaundice (β = -5.2; 95% confidence interval -9.6 to -0.7, p = 0.023) and long postoperative hospital stay (β = -7.0; 95% confidence interval - 13.4 to -0.7, p = 0.031) were significantly associated with BMD index decrease until the 1st year after pancreaticoduodenectomy.

CONCLUSIONS

This study identified a rapid decrease of BMD after pancreaticoduodenectomy. Preoperative obstructive jaundice and long postoperative hospital stay are significant risk factors for decreased BMD after pancreaticoduodenectomy.