**12. Treatment of metabolic bone disorder**

The high prevalence of CP-related osteopathy can be partly explained by common risk factors such as cigarette smoking and heavy alcohol consumption.

### *Current Approaches in Chronic Pancreatitis DOI: http://dx.doi.org/10.5772/intechopen.98214*

Furthermore, chronic inflammation caused by CP is likely to contribute to a proinflammatory environment that leads to net bone loss [130]. Ultimately, patients with CP are at high risk of vitamin D deficiency, especially when EPI is present [131].

CP-associated osteopathy management follows general treatment guidelines, including calcium and vitamin D supplementation, weight-bearing exercises, and smoking cessation. Oral bisphosphonate therapy, when indicated, should be closely monitored to ensure that patients tolerate it. If patient cannot tolerate it, switching to an alternative anti-resorptive therapies should be considered. Lastly, uncontrolled data indicates that PERT could potentially reduce the risk of fractures in subjects with CP, but further studies are required before this can be universally recommended [132].

In other gastrointestinal conditions, such as celiac disease, cholestatic liver disease, and inflammatory bowel disease, baseline screening with a DEXA scan has been widely adopted. That is why, baseline screening with DEXA in CP is reasonable considering that CP has higher odds of fractures compared with other gastrointestinal conditions [67, 71].
