Metabolic bone disease of total parenteral nutrition: course after changing from casein to amino acids in parenteral solutions with reduced aluminum content.
Bone disease with total parenteral nutrition (TPN) has been attributed to aluminum loading or vitamin D therapy. We studied 17 patients who first received TPN containing casein hydrolysate with high Al and ergocalciferol (25 micrograms/d) for 6-72 mo followed by TPN containing amino acids with reduced Al and ergocalciferol (5 micrograms/d) for 9-58 mo. We also did a cross-sectional study of 22 patients receiving casein and ergocalciferol (25 micrograms/d) compared with 46 patients receiving amino acids and ergocalciferol (5 micrograms/d) for 6-58 mo. Bone formation was higher and osteoid area, bone-surface stainable Al and total bone Al were lower with amino acid TPN than with casein TPN. Bone formation varied inversely with both plasma Al and bone-surface Al, suggesting that plasma or bone-surface Al, acquired during TPN, can reduce bone formation and lead to patchy osteomalacia. Serum levels of iPTH and 1,25-dihydroxyvitamin D were higher with amino acid TPN.
D000535:Aluminum / Q000008:administration & dosage*; D000596:Amino Acids / Q000008:administration & dosage*; D001846:Bone Development; D001851:Bone Diseases, Metabolic / Q000209:etiology* / Q000378:metabolism; D001842:Bone and Bones / Q000032:analysis; D002118:Calcium / Q000032:analysis; D002364:Caseins / Q000009:adverse effects*; D003404:Creatinine / Q000032:analysis; D004872:Ergocalciferols / Q000032:analysis; D006801:Humans; D008657:Metabolic Clearance Rate; D010018:Osteomalacia / Q000209:etiology; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D011492:Protein Hydrolysates / Q000009:adverse effects*
D000596:Amino Acids; D002364:Caseins; D004872:Ergocalciferols; D011492:Protein Hydrolysates; C026375:trypticase-soy broth; D003404:Creatinine; D000535:Aluminum; D002118:Calcium