Burden of Metabolic Bone Disease in Patients with IgG4-Related Disease With and Without Autoimmune Pancreatitis: A Cross-Sectional Study.

Introduction: Patients with IgG4-related disease (IgG4-RD) have risk factors for metabolic bone disease (MBD), yet data are lacking on the prevalence of MBD in IgG4-RD. We assessed screening frequency and prevalence of MBD in patients with IgG4-RD with and without pancreatic involvement.

Methods: Using a IgG4-RD registry, we extracted details from medical records related to MBD in patients who actively follow in our system. Living patients with contact information available were invited to complete surveys detailing MBD and associated characteristics.

Results: Seventy patients met criteria for medical records review (n=17 with pancreatic involvement). 51% had taken proton pump inhibitors (PPIs), and 30% had investigator-determined MBD. Compared to the US population, the age-standardized prevalence of osteoporosis in the IgG4-RD cohort was higher among both females (28.1% vs. 19.6%, p=0.40) and males (8.3% vs. 4.4%, p=0.48), though this did not achieve statistical significance. Mean T-scores at all sites were numerically lower in patients with pancreatic involvement than those without (all p>0.1).In patient-reported data (n=105), despite 62% of patients reporting ≥3 months of glucocorticoid exposure, only 36% had a DXA performed. Of 15 patients for whom pharmacologic MBD treatment was recommended, 8 (53%) reported adherence to this recommendation.

Conclusions: The burden of MBD and its risk factors is high in patients with IgG4-RD, yet screening and treatment is low. While our study was underpowered to detect statistical differences, there may be a greater burden of MBD in patients with pancreatic involvement. Screening and treatment of MBD should be emphasized in these patients.