LONG TERM PARENTERAL NUTRITION IN CHILDREN (PN): NON ALUMINUM DEPENDENT OSTEOPATHY

We previously reported a bone disease with PN related aluminum toxicity. In a prospective study, we assessed the trabecular bone mineral content of 14 asymptomatic patients, age 9.1 ± 3.9 years, on long term parenteral nutrition (PN). The PN was started in the first month of life in 11 pts. and between 3 and 5 years of age in 3 pts. In all children PTH, calcitonin, Vit D, 25-OH, Vit D, 1, 25-(OH)2 and serum aluminum level were within normal range. Computerized tomography was performed in the lumbar region. The mean trabecular bone mineral content measurement of L1, L1, L3 and L4 was compared to the mineral content of a normal population of the same age and sex. 7/14 pts. had trabecular bone mineral content below -2 SD (108.1 ± 21.6 mg/cc; 62.9% ± 13.9% of the normal mineral content), 5/14 pts were below -1 SD (142.4 ± 12.8 mg/cc; 83.9% ± 6.25%) and 2/14 had normal mineral content. There is a significant correlation (r=0.56, p<0.05) between the duration of PN and the decrease in mineral content. In 50% of the pts., there is a loss of more than 35% of the trabecular bone mineral content, even if they are asymptomatic. Children on long term PN who have never been aluminum toxic still may have a PN dependent osteopathy. The basis for this is unknown.