Increase in Lumbar Spine Bone Mineral Content in Patients on Long‐Term Parenteral Nutrition Without Vitamin D Supplementation

Verhage, Albert H.; Cheong, Wei Kiong; Allard, Johane P.; Jeejeebhoy, Khursheed N.

doi:10.1177/0148607195019006431

Cited by 62 publications

(30 citation statements)

References 27 publications

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“…Metabolic acidosis, excessive aminoacid infusion, insufficient vitamin D and mag nesium supply are some other factors ascribed to the onset of bone disease (13). Vitamin D is not effective in increasing calcium absorption in patients with intes tinal failure, and its excess may be associated with bone disease (14). Hypomagnesemia is common in SBS pa tients, and may decrease the parathormone secretion and action, resulting in an insufficient production of 1,25 hydroxy vitamin D, thus contributing to lower calcium bone storage (15).…”

Section: Discussionmentioning

confidence: 99%

Bone mineral density in short bowel syndrome: correlation with BMI and serum vitamins C, E and K

Braga

Bizari

Suen

et al. 2015

Arch. Endocrinol. Metab.

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Objective: Bone loss has been established as a major extra-intestinal complication of short bowel syndrome (SBS). The purpose of this study was to correlate bone mineral density (BMD) with body mass index (BMI), serum vitamin and mineral levels in patients with SBS. Material and methods: The study was conducted on 13 patients (8 male and 5 female, 54.7 ± 11.4 years) with SBS (residual small bowel length of 10 to 100 cm). We determined the food ingestion, anthropometry, serum levels of vitamins C, A, D, E and K, as well as serum and urinary levels of phosphorus and calcium. BMD was measured by dual-energy x-ray absorptiometry (DXA). Results: Osteopenia and osteoporosis was diagnosed in all but one SBS patient. Serum levels of vitamin D were low in all volunteers. Sixty-one percent of patients had vitamin E deficiency; hypovitaminosis A and C occurred in one subject. BMI and C, E and K vitamin serum levels correlated with T-score of BMD. Conclusions: Osteopenia and osteoporosis were common in SBS patients. There was a correlation between BMD and the serum levels of vitamins C, E and K, an indicative that such vitamins may influence bone health. Arch Endocrinol Metab. 2015;59(3):252-8

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Section: Discussionmentioning

confidence: 99%

Bone mineral density in short bowel syndrome: correlation with BMI and serum vitamins C, E and K

Braga

Bizari

Suen

et al. 2015

Arch. Endocrinol. Metab.

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“…Casein is no longer used, but the possibility of aluminum overloading continues to be a concern [43,44]. Excessive vitamin D can also be deleterious to bone metabolism by suppressing PTH secretion and stimulating bone resorption, with a potential benefit when the supplement is discontinued [45,46]. Therapies to minimize BMD loss for patients on TPN include bisphosphonates, calcitonin, and calcium supplementation; however, experimental approaches using subcutaneous PTH may be beneficial because of the osteoblastic effect of this agent.…”

Section: Bone Diseasementioning

confidence: 99%

Metabolic and catheter complications of parenteral nutrition

Ghabril

Aranda-Michel

Scolapio

2004

Curr Gastroenterol Rep

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Since its introduction in the 1960s, total parenteral nutrition (TPN) has played a vital role in improving clinical outcomes for patients with acute and chronic illnesses. The evolution of TPN solutions and vascular access techniques, combined with an increased awareness and better understanding of the physiology of TPN, have improved the safety of this therapy. Nevertheless, complications are not uncommon and can be life threatening. This article provides an updated review on the metabolic and catheter complications associated with TPN.

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“…Adult patients on long-term PN are at risk of developing metabolic bone disease, characterized by reduced serum 25-hydroxyvitamin-D (S-25-OHD) concentrations, negative calcium balance and decreased bone mineralization [10,11,12]. Osteoporosis [defined as a BMD T-score <-2.5 in adults (measured with dual-energy X-ray absorptiometry, DXA) according to the WHO] is reported in 32-67% of adults on long-term PN [13,14,15,16].…”

Section: Introductionmentioning

confidence: 99%

Risk of Metabolic Bone Disease is Increased Both during and after Weaning off Parenteral Nutrition in Pediatric Intestinal Failure

Mutanen¹,

Mäkitie

Pakarinen³

2013

Horm Res Paediatr

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Aim: To assess bone health in pediatric intestinal failure (IF). Methods: A population-based cohort of 41 IF patients (age 9.9 years) underwent evaluation of bone mineral density (BMD), bone biochemistry, nutritional status and growth. Eleven patients remained on parenteral nutrition (PN) after 69 months. Thirty had weaned off PN 9.0 years earlier (mean), i.e. after 30 months on PN. Results: The majority of patients had lumbar spine or femoral BMD Z-score ≤-1.0 (70%), vitamin D deficiency (serum 25-hydroxyvitamin-D, S-25-OHD, <50 nmol/l, 41%) or secondary hyperparathyroidism (plasma parathyroid hormone >47 ng/l, 44%), equally during and after weaning off PN. Hyperparathyroidism was absent when S-25-OHD was >80 nmol/l. Until puberty, height (-1.4 to -0.8, age 1-12) and weight Z-scores (-1.3 to -0.5, age 1-16) were below the normal mean (p < 0.05). Small bowel length associated with S-25-OHD levels (r = 0.489, p = 0.013). In a multivariate model, time after weaning off PN (β = -0.597, p = 0.001), duration of PN (β = -0.466, p = 0.006) and calcium intake (β = -0.331, p = 0.035) predicted decreased lumbar spine BMD. Conclusions: In pediatric IF, vitamin D insufficiency, secondary hyperparathyroidism and decreased BMD are common. BMD, vitamin D, calcium and nutritional status should be closely monitored during and after weaning off PN to ensure sufficient vitamin D and mineral substitution for normal growth and bone mass attainment.

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Increase in Lumbar Spine Bone Mineral Content in Patients on Long‐Term Parenteral Nutrition Without Vitamin D Supplementation

Abstract: In selected patients with depressed PTH levels, long-term withdrawal of vitamin D during HPN increases LSBMC and levels of PTH and 1,25(OH)2D. There is no reduction of the mean level of 25-hydroxyvitamin D.

Cited by 62 publications

References 27 publications

Bone mineral density in short bowel syndrome: correlation with BMI and serum vitamins C, E and K

Bone mineral density in short bowel syndrome: correlation with BMI and serum vitamins C, E and K

Metabolic and catheter complications of parenteral nutrition

Risk of Metabolic Bone Disease is Increased Both during and after Weaning off Parenteral Nutrition in Pediatric Intestinal Failure

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