Introduction The prevalence of metabolic bone disease (MBD) in Type 3 Intestinal Failure (IF) has been reported at 84% (1) but it is unclear if long term home parenteral nutrition (HPN) is associated with a consistent decline in bone mineral density (2). The aim of this study was to evaluate the prevalence of MBD and the progression of BMD in a large cohort of patients with CIF managed at a national referral centre.
Method The prevalence of MBD in patients requiring HPN was evaluated retrospectively from a maintained database at a national U.K. referral unit in 2016. BMD was measured using DEXA scan and WHO criteria were used to categorise patients into normal (T score −1 and above), osteopenia (T score between −1 and −2.5), and osteoporosis (T score −2.5 and below). BMD progression was assessed by reviewing follow up DEXA scan results. Patient demographics along with HPN requirements and underlying disease were recorded.
Results 140 patients (mean age 54 years; 87 female)) with CIF had a DEXA scan performed. 85.7% patients were dependent on PN for calories and 11.4% were fluid dependent only.
106 (75.7%) patients had a diagnosis of MBD (58 (41%)) osteoporosis; 48 (34.3%) osteopenia). 34 (24.3%) patients had a normal BMD.
47 patients had follow up of BMD with a 2nd DEXA bone scan (time between DEXA scans, mean=2.4 years, min=1, max=5). Deterioration in BMD was demonstrated in 12 (26%) patients with change in WHO classification (7=osteoporosis from osteopenia; 5=osteopenia from normal). 34 (72%) showed no change in classification (osteoporosis n=21, osteopenia n=11, normal n=2). Only 1 (2%) patient had improvement in classification from osteoporosis to osteopenia.
Aetiology of IF was classified into intestinal dysmotility (20%); post-operative surgical complications (26.4%); Crohn’s disease (32.9%); ischaemia (18.6%) and malignancy (2.1%). Prevalence of MBD differed between groups, with Crohn’s patients demonstrating the highest prevalence of MBD, 98% (52% osteoporosis, 46% osteopenia).
Conclusion We report a MBD prevalence in patients with CIF of 75.7%, comparable to other series),1 with a quarter of patients demonstrating a decline in T score. These data support the need for surveillance and treatment of MBD in patients needing HPN.2
. Pironi L, et al. Clin Nutr2002;21:289e96.
. Pironi L, et al. Clin Nutr2016; 35: 247–307.
Disclosure of Interest None Declared
- Intestinal failure
- Parenteral nutrition
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