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.