Metabolic bone disease in patients receiving long-term total parenteral nutrition.
We have prospectively investigated calcium and bone metabolism in 16 patients receiving total parenteral nutrition for periods ranging from 7 to 89 months. In 12 patients, bone biopsies at 6 to 73 months after the start of parenteral nutrition showed osteomalacia. Plasma 25-hydroxyvitamin D levels were normal in all patients. Seven persons developed hypercalcemia, and 10 had hypercalciuria with a negative calcium balance. Serum phosphorus was normal and plasma parathyroid hormone level, normal or decreased. Three patients with the severest form of the disease had vitamin D withdrawn from their solutions. Subsequently, urinary calcium decreased, and serum calcium became normal; two persons reverted to a positive calcium balance. Thus, patients receiving total parenteral nutrition may develop metabolic bone disease characterized by osteomalacia, hypercalcemia, hypercalciuria, and a negative calcium balance. This may be caused by both defective mineralization and increased bone resorption induced by vitamin D, its metabolites, or another unrecognized factor.
D000328:Adult; D000368:Aged; D001851:Bone Diseases, Metabolic / Q000209:etiology* / Q000378:metabolism; D001862:Bone Resorption / Q000209:etiology; D002118:Calcium / Q000378:metabolism; D005260:Female; D006801:Humans; D006887:Hydroxycholecalciferols / Q000378:metabolism; D007410:Intestinal Diseases / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010018:Osteomalacia / Q000209:etiology; D010281:Parathyroid Hormone / Q000378:metabolism; D010288:Parenteral Nutrition / Q000009:adverse effects*; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*; D010758:Phosphorus / Q000378:metabolism; D014807:Vitamin D / Q000008:administration & dosage / Q000009:adverse effects
D006887:Hydroxycholecalciferols; D010281:Parathyroid Hormone; D014807:Vitamin D; D010758:Phosphorus; D002118:Calcium