Clinical influence of osteopenia on outcomes of pancreaticoduodenectomy: a review of current evidence

This review examines the clinical significance of osteopenia in patients undergoing pancreaticoduodenectomy (PD). It highlights that disturbances in bone mineral density (BMD) are highly prevalent among PD candidates (40-50% osteopenia, 20-30% osteoporosis) and progress dramatically after surgery, especially within the first year. Preoperative osteopenia is an independent risk factor for postoperative pancreatic fistula (POPF) – one of the most severe complications. Furthermore, the syndrome of osteosarcopenia (combined osteopenia and sarcopenia) is associated with worse overall and recurrence-free survival.

The key pathogenetic mechanism is postoperative pancreatic exocrine insufficiency (PEI), leading to malabsorption of fat-soluble vitamins (especially D and K), calcium, and other nutrients critical for bone metabolism. Chronic systemic inflammation and anatomical changes post-resection also play significant roles.

For the prevention and treatment of metabolic bone disease, lifelong pancreatic enzyme replacement therapy (PERT) is considered the cornerstone, combined with supplementation of vitamin D and calcium at individually tailored, often higher doses. Systematic BMD screening using DXA or CT data, starting from the preoperative period, is recommended. Pharmacological therapy (bisphosphonates, denosumab, anabolic agents) is indicated for diagnosed osteoporosis. Optimal management requires a multidisciplinary approach, including long-term follow-up, nutritional status correction, and lifestyle modification.

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