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Pediatric intestinal failure: Predictors of metabolic bone disease
Farokh R Demehri1, Siddartha Simha1, Lauren Stephens1
1Department of Surgery, Section of Pediatric Surgery, University of Michigan Health System, Ann Arbor, MI.
Insights
Pediatric intestinal failure (IF) patients face a high risk of metabolic bone disease (MBD). Longer dependence on parenteral nutrition (PN) is a key predictor of decreased bone mineral density (BMD) in these children.
Area of Science:
- Pediatric Gastroenterology
- Endocrinology
- Nutrition Science
Background:
- Pediatric intestinal failure (IF) poses significant challenges to nutrient absorption and overall health.
- Metabolic bone disease (MBD) is a serious complication in children with IF, impacting growth and skeletal integrity.
- Understanding the risk factors for MBD in this vulnerable population is crucial for timely intervention.
Purpose of the Study:
- To identify specific risk factors associated with the development of MBD in pediatric patients with IF.
- To investigate the relationship between bone mineral density (BMD) and various clinical parameters in this cohort.
Main Methods:
- A retrospective study involving 36 pediatric IF patients screened for MBD.
- Bone mineral density (BMD) was assessed using dual-energy X-ray absorptiometry (DXA).
- Multivariate stepwise linear regression analysis was employed to determine predictors of MBD.
Main Results:
- 50% of patients exhibited low bone mineral density (BMD Z-score < -1.0).
- Vitamin D deficiency (25-hydroxyvitamin-D < 30 ng/ml) was prevalent in 63.8% of patients.
- Duration of parenteral nutrition (PN) dependence was a significant predictor of decreased BMD (p=0.006).
Conclusions:
- Pediatric IF is strongly linked to an increased risk of MBD.
- The duration of PN dependence is a critical factor predicting MBD in these children.
- Enhanced monitoring of BMD and development of improved MBD therapies are essential for managing pediatric IF.
Purpose:
The purpose of this study was to identify risk factors for the development of metabolic bone disease (MBD) in pediatric intestinal failure (IF).
Methods:
A retrospective single-center study of 36 pediatric IF patients who were screened for MBD was performed. Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry (DXA). Simple regression analysis was initially performed to screen predictors, followed by multivariate step-wise linear regression analysis to identify risk factors of MBD.
Results:
Mean lumbar spine BMD Z-score was -1.16 ± 1.32, and 50.0% of patients had a BMD Z-score less than -1.0. Deficiency of 25-hydroxyvitamin-D (25-OHD <30 ng/ml) was present in the 63.8% of patients, while 25.0% had hyperparathyroidism (intact parathyroid hormone (PTH)>55 pg/ml). Seven patients (19.4%) had bone pain, of which 4 (11.1%) suffered a pathologic fracture. Using multivariate analysis, parenteral nutrition (PN) duration predicted decreased BMD (B=-0.132, p=0.006). Serum 25-OHD nonsignificantly correlated with BMD Z-score (B=0.024, p=0.092). Interestingly, repeat DXA after increasing vitamin D supplementation showed no improvement in BMD Z-score (-1.18 ± 1.49 vs -1.36 ± 1.47, p=0.199).
Conclusions:
Pediatric IF is associated with a significant risk of MBD, which is predicted by the duration of PN-dependence. These findings underscore the importance of BMD monitoring. Better therapies for treating IF-associated MBD are needed.
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