title: Decreased bone turnover markers in children on long-term parenteral nutrition (PN) for intestinal failure (IF).
abstract: BACKGROUND
  Metabolic bone disease (MBD) is a well-recognized but poorly understood complication of long-term parenteral nutrition (PN). Bone histomorphometry in adults has provided useful information but does not provide quantitative measures of bone resorption and is to invasive for children. Measurement of bone turnover markers provides an alternative less invasive approach. We therefore aimed to measure bone turnover markers in children on long-term PN for intestinal failure (IF), and to compare them to age- and gender-matched controls.
  
  
  METHODS
  Serum concentrations of osteocalcin (OC), bone-specific alkaline phosphatase (BSAP), and c-telopeptide (CTx) were measured in IF patients treated at a multidisciplinary intestinal rehabilitation and home PN program at the Hospital for Sick Children, Toronto, Canada. Age- and gender-matched control participants were recruited for comparison.
  
  
  RESULTS
  A total of 13 IF patients and 20 control participants were recruited. IF patients had lower serum OC and CTx concentrations when compared with controls: 42.43 ± 11.54 vs 68.39 ± 20.95 µg/L (P < .01) and 7.454 ± 2.17 vs 9.246 ± 1.92 (P < .05; mean ± SD) µg/L for OC and CTx, respectively. In a subgroup of 9 IF patients for whom BMD was available, OC and CTx concentration were negatively correlated to BMD (g/cm(2)) and BMD z score.
  
  
  CONCLUSIONS
  Bone turnover markers may be useful indicators for identifying children on long-term PN at risk of MBD. Further studies are needed to validate the current results and determine the factors that influence the occurrence and evolution of MBD in children on PN.
authors: Research Institute, The Hospital for Sick Children, Toronto, Canada.
authors: Charlène
authors: C
authors: Derepas
authors: Research Institute, The Hospital for Sick Children, Toronto, Canada Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada.
authors: Christina
authors: C
authors: Kosar
authors: Research Institute, The Hospital for Sick Children, Toronto, Canada Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada The Department of Pediatrics, University of Toronto, Toronto, Canada.
authors: Yaron
authors: Y
authors: Avitzur
authors: Research Institute, The Hospital for Sick Children, Toronto, Canada Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada The Department of Surgery, University of Toronto, Toronto, Canada.
authors: Paul W
authors: PW
authors: Wales
authors: Research Institute, The Hospital for Sick Children, Toronto, Canada Group for Improvement of Intestinal Function and Treatment (GIFT), The Hospital for Sick Children, Toronto, Canada glenda.courtney-martin@sickkids.ca.
authors: Glenda
authors: G
authors: Courtney-Martin
mesh_terms: D000293:Adolescent; D000469:Alkaline Phosphatase / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001835:Body Weight; D015519:Bone Density / Q000187:drug effects; D001851:Bone Diseases, Metabolic / Q000473:pathology*; D016723:Bone Remodeling; D001842:Bone and Bones / Q000503:physiopathology; D002136:Calcium, Dietary / Q000008:administration & dosage / Q000097:blood; D002170:Canada; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D024042:Collagen Type I / Q000097:blood; D004032:Diet; D005260:Female; D006801:Humans; D007223:Infant; D007410:Intestinal Diseases / Q000628:therapy*; D008297:Male; D015596:Nutrition Assessment; D015675:Osteocalcin / Q000097:blood; D010288:Parenteral Nutrition / Q000009:adverse effects*; D010455:Peptides / Q000097:blood; D010710:Phosphates / Q000008:administration & dosage / Q000097:blood; D010865:Pilot Projects; D014807:Vitamin D / Q000008:administration & dosage / Q000097:blood
chemical_list: D015415:Biomarkers; D002136:Calcium, Dietary; D024042:Collagen Type I; D010455:Peptides; D010710:Phosphates; C052929:collagen type I trimeric cross-linked peptide; D015675:Osteocalcin; D014807:Vitamin D; D000469:Alkaline Phosphatase
keywords: bone alkaline phosphatase; bone disease; c-telopeptide; osteocalcin