Osteoporosis in patients on long-term home parenteral nutrition: a longitudinal study.
The prevalence of osteoporosis was investigated in 88 patients with intestinal failure (IF). Osteoporosis was found in 67%, dependent of body mass index and age when IF occurred. In 56 patients on HPN, followed prospectively, changes in bone density were dependent on the duration of HPN; older patients had a higher increase.


BACKGROUND
It has been suggested that low bone mass and negative bone balance may occur in adult patients receiving home parenteral nutrition (HPN). The aim of this study was to assess prospectively the prevalence of osteoporosis in intestinal failure (IF) patients and the changes in bone mineral density in those on long-term HPN and to analyze the factors that may influence the occurrence and evolution of osteoporosis.


METHODS
Bone mineral density was measured at the lumbar spine and femoral neck in 88 IF patients.


RESULTS
At the first bone mineral density determination (baseline), the prevalence of osteoporosis was 67% in this population (median age, 52 years). Ten percent of the patients with osteoporosis experienced fragility fractures. Osteoporosis was independent of age and gender but occurred earlier in patients who had received corticosteroids. At baseline, the lumbar Z-score was positively correlated mainly to body mass index and age when IF occurred; these two parameters explained 34% of the Z-score. Repeated measurements were performed in 56 patients during long-term HPN (mean duration, 5.5 +/- 1.2 years). The changes in Z-score at the lumbar spine were dependent on the age when IF occurred and on the duration of HPN, with a synergistic effect between them. The older the patients, the higher the increase in Z-score during HPN.


CONCLUSIONS
HPN had no deleterious effect on cortical bone and actually improved trabecular bone in patients whose intestinal disease started after the age of 21 years.
Cohen-Solal
M
M
INSERM U349, Hopital Lariboisiere, Paris, France. martine.cohen-solal@inserm.lrb.ap-hop-paris.fr
Baudoin
C
C
Joly
F
F
Vahedi
K
K
D'Aoust
L
L
De Vernejoul
M C
MC
Messing
B
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D015519:Bone Density / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000178:diet therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D016331:Parenteral Nutrition, Home / Q000009:adverse effects*; D015995:Prevalence; D011446:Prospective Studies; D013997:Time Factors