PREVALENCE OF METABOLIC BONE DISEASE IN A CANADIAN POPULATION OF PATIENTS RECEIVING PARENTERAL NUTRITION

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PREVALENCE OF METABOLIC BONE DISEASE IN A CANADIAN POPULATION OF PATIENTS RECEIVING PARENTERAL NUTRITION

MP Stapleton, G Kline, N Hershfield

University of Calgary, Calgary, Alberta

This study describes the prevalence of metabolic bone disease (MBD) and risk factors for MBD in a Canadian population of patients receiving parenteral nutrition (PN). Reports of MBD in American PN populations have reported prevalence ranging from 40%-100%; however, the mechanism of MBD is unknown and the role of other risk factors unclear.

Data were collected from 13 patients currently receiving PN through the Calgary Health Region’s PN Clinic who had dual energy X-ray absorptiometry (DEXA) testing of bone mineral density within the last 2 years. In addition to T scores, the presence or absence of other risk factors (smoking, steroid treatment, post-menopausal status women, anti-epileptics, heparin treatment, hypogonadism, and Crohn’s disease) and duration of PN were determined. The study was descriptive as the sample size available was small.
Only 2/13 patients (15%) had normal BMD by DEXA (T³1.5). Of the 85% with abnormal DEXA scores, 5/13 (38%) had osteopenia (–2.5<T£1.5), while 6/13 (46%) were osteoporotic (T£2.5). No patients with >1 risk factor had normal DEXA scores. No patients receiving PN for >10 years had normal DEXA scores; only 2/8 patients (25%) on PN <10 years had normal DEXA scores.

This study shows that MBD is common in patients receiving PN, particularly with increasing duration of PN. Most PN patients have multiple risk factors for MBD. Because of the small number of patients on PN, studies of management are difficult; creation of a Canadian registry of PN patients would increase sample size and aid in further studies of MBD in this population.

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