Prevalence of bone disease in patients on home parenteral nutrition.
OBJECTIVE
The epidemiology of bone disease in home parenteral nutrition (HPN) is unknown. The aim of this paper is to evaluate the prevalence and severity of reduced bone mineral density (BMD) in long-term HPN.


METHODS
Cross-sectional, multicentre study including patients who within the last 12 months had their BMD assessed by dual-energy-X-ray absorptiometry after at least 6 months of HPN. Data on bone pain and fractures, the primary gastrointestinal diseases, nutritional and rehabilitation status and HPN regimen were reviewed. Both the T-score (no. of SD below mean BMD of young subjects) and the Z-score (no. of SD from normal BMD values corrected for sex and age) were analysed.


RESULTS
A T -score <-1 at any site of assessment was observed in 84% of the 165 patients enrolled (<or= -2.5 in 41%). Bone pain occurred in 35% and bone fracture in 10% of patients. Both T - and Z-scores were significantly lower in symptomatic patients. The frequency of bone disease was higher in post-menopausal women but did not differ among the subgroups of the primary diseases. Stepwise regression analysis showed the lumbar spine Z -score positively associated with the age at starting HPN and the femoral neck Z-score positively associated with the body mass index.


CONCLUSIONS
Bone disease was present in most of the patients on HPN, was of severe degree in one-half of them and symptomatic in one-third. The BMD Z-score appeared predictive of the risk of fracture. The prevalence of bone disease did not differ between the various primary diseases. Age at starting HPN and body mass index appeared to be the major factors associated with BMD Z-scores.
Department of Internal Medicine and Gastroenterology, University of Bologna, Italy
Loris
L
Pironi
Antonio M Morselli
AM
Labate
Marek
M
Pertkiewicz
Jerzy
J
Przedlacki
Lone
L
Tjellesen
Michael
M
Staun
Antonella
A
De Francesco
Paola
P
Gallenca
Francesco W
FW
Guglielmi
André
A
Van Gossum
Paolo
P
Orlandoni
Franco
F
Contaldo
Jose M Moreno
JM
Villares
D015502:Absorptiometry, Photon / Q000379:methods; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015519:Bone Density; D001847:Bone Diseases / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000009:adverse effects*; D015995:Prevalence; D012044:Regression Analysis; D012189:Retrospective Studies