Bone mineral content in infants and children with chronic cholestatic liver disease.
OBJECTIVE
To assess bone mineral content (BMC) status and serum vitamin D metabolite levels of infants and children with chronic cholestatic liver disease. To determine if severity of bone disease in these patients correlates with serum vitamin D metabolite levels.


METHODS
We measured radial BMC with the use of a single-beam photon absorptiometer and serum vitamin D metabolite levels in 56 patients with chronic cholestasis seen at our institution from 1985 through 1991. Patients were divided into two groups according to age.


RESULTS
In group 1 (n = 37; age 2 to 22 months), decreased levels of BMC were seen as early as the first few months of life, with sharp decline observed with increasing age (approaching 3 to 5 standard deviations [SD] below the mean, P < .0003). Older patients (group 2, n = 19; age 2 to 20 years) had BMC values which clustered between 2 and 4 SD below the mean throughout the age range. Although a downward trend also was noted with increasing age, this was not statistically significant. Despite correction for weight-age or height-age, BMC was decreased in most of these patients. No correlation between severity of osteopenia and serum levels of 25(OH)-vitamin D and 1,25(OH)2-vitamin D was observed in either infants or older children.


CONCLUSIONS
Decreased bone mineralization, as a complication of chronic cholestatic conditions, is a disease process that begins early in infancy, rapidly worsens with increasing age and hepatic dysfunction, and remains relatively stable in children with more stable liver disease.
Division of Gastroenterology and Nutrition, Children's Hospital Research Foundation, Cincinnati, OH 45229-2899.
E A
EA
Argao
B L
BL
Specker
J E
JE
Heubi
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015519:Bone Density; D002648:Child; D002675:Child, Preschool; D002780:Cholestasis, Intrahepatic / Q000097:blood / Q000503:physiopathology*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D014807:Vitamin D / Q000378:metabolism
D014807:Vitamin D