title: Metabolic bone disease in pediatric intestinal failure patients: prevalence and risk factors.
abstract: OBJECTIVE
  Patients with intestinal failure (IF) are known to have impaired absorption of nutrients required for maintenance of skeletal mass. Rates and risk factors of low bone mineral density (BMD) are unknown in pediatric IF patients.
  
  
  METHODS
  Following IRB approval, patients with IF having undergone DXA scans were identified and laboratory, clinical, and nutritional intake variables were recorded. Low BMD was defined by a z-score of less than or equal to -2.0. Univariate followed by multivariable regression analysis was performed.
  
  
  RESULTS
  Sixty-five patients underwent a total of 99 routine DXA scans. Twenty-seven (41%) had vitamin D deficiency, 22 (34%) had low BMD, and nineteen (29%) had a history of fractures. Variables noted to be associated with low BMD (p<0.1) on univariate analysis were considered for multivariable regression. Multivariable regression identified WAZ and serum calcium levels (p<0.05) as independent predictors of low BMD z-score. None of the other evaluated factors were associated with the risk of low BMD. Low BMD was not associated with risk of fractures.
  
  
  CONCLUSIONS
  There is a significant incidence of low BMD in children with IF. WAZ and lower serum calcium levels are associated with risk of low BMD. Additional long term prospective studies are needed to further characterize the risk factors associated with low BMD.
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital and Harvard Medical School, USA.
authors.forename: Faraz A
authors.initials: FA
authors.lastname: Khan
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital and Harvard Medical School, USA.
authors.forename: Jeremy G
authors.initials: JG
authors.lastname: Fisher
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital and Harvard Medical School, USA.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Bairdain
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital and Harvard Medical School, USA.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Sparks
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital and Harvard Medical School, USA; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital and Harvard Medical School, USA.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital and Harvard Medical School, USA.
authors.forename: Biren P
authors.initials: BP
authors.lastname: Modi
authors.affiliation: Division of Gastroenterology, Hepatology Nutrition, Boston Children's Hospital and Harvard Medical School, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Duggan
authors.affiliation: Department of Pediatric Surgery, Boston Children's Hospital and Harvard Medical School, USA. Electronic address: tom.jaksic@childrens.harvard.edu.
authors.forename: Tom
authors.initials: T
authors.lastname: Jaksic
mesh_terms: D000293:Adolescent; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000453:epidemiology*; D002118:Calcium / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D014808:Vitamin D Deficiency / Q000453:epidemiology
chemical_list: D002118:Calcium
keywords: 25-OH D deficiency; Bone mineral density; DEXA; Fractures; Intestinal failure; Metabolic bone disease; Pediatric