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.
Argao
E A
EA
Division of Gastroenterology and Nutrition, Children's Hospital Research Foundation, Cincinnati, OH 45229-2899.
Specker
B L
BL
Heubi
J E
JE
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