Parenteral nutrition osteoporosis with

In adults receiving long-term parenteral nutrition, despite its anabolic effects on other tissues, there is no improvement in bone density. Infants treated with parenteral nutrition from birth also develop low bone density for age, suggesting that parenteral nutrition treatment in some way contributes to the osteopenia (5). A 17% long-term increase in spinal bone mineral content has been shown in patients who have received parenteral nutrition solntions without vitamin D. However, this rise was nearly balanced by a 15% fall in hip bone mineral content (115). In a Danish study of bone mineral content in adults receiving home parenteral nutrition for short bowel syndrome, despite the fact that all were on free oral intake as a supplement to the parenteral nutrition, 47% had mandibular osteoporosis while 33% had osteoporosis in the forearm and radiographic changes of osteoporotic fractures in the vertebral column. Dental and periodontal tissues were normal (116). 

Crohn s disease of the small bowel classically affects the ileocaecal region, although any part of the gastrointestinal tract may be involved, from the mouth downwards. Patients with small bowel involvement are frequently malnourished and specialist dietetic input is essential enteral or parenteral nutrition may be required. Osteoporosis is common, particularly if corticosteroid consumption has been high. 

Musculoskeletal Bone area and bone mineral content in lumbar spine, hip, and whole body were measured with dual radiograph absorptiometry in 59 children aged 13-15 who had been bom preterm and randomly assigned standard or aluminium-depleted parenteral nutrition solutions during the neonatal period. Those who had been randomly assigned to standard parenteral nutrition solutions had lower lumbar spine bone mineral content, apparently explained by a reduction in bone size. In nonrandomized analyses, children who were exposed as neonates to aluminium above the median (55 micrograms/kg) had lower hip bone mineral content, independent of bone or body size. The authors concluded that neonates who are exposed to parenteral aluminium may have reduced lumbar spine and hip bone mass during adolescence, potential risk factors for later osteoporosis, and hip fracture. 

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