Metabolic Bone Disease in Children with Intestinal Failure and Long-Term Parenteral Nutrition: A Systematic Review

Abstract

Metabolic bone disease (MBD) is a possible complication of intestinal failure (IF), with a multi-factorial pathogenesis. The reduction of bone density (BMD) may be radiologically evident before manifestation of clinical signs (bone pain, vertebral compression, and fractures). Diagnosis relies on dual-energy X-ray absorptiometry (DXA). Incidence and evolution of MBD are not homogeneously reported in children. The aim of this systematic review was to define the prevalence of MBD in IF children and to describe risk factors for its development. A comprehensive search of electronic bibliographic databases up to December 2021 was conducted. Randomized controlled trials; observational, cross-sectional, and retrospective studies; and case series published between 1970 and 2021 were included. Twenty observational studies (six case-control) were identified and mostly reported definitions of MBD based on DXA parameters. Although the prevalence and definition of MBD was largely heterogeneous, low BMD was found in up to 45% of IF children and correlated with age, growth failure, and specific IF etiologies. Data demonstrate that long-term follow-up with repeated DXA and calcium balance assessment is warranted in IF children even when PN dependence is resolved. Etiology and outcomes of MBD will be better defined by longitudinal prospective studies focused on prognosis and therapeutic perspectives.

Bone health in children undergoing solid organ transplantation

“…The underlying etiology is multifactorial and includes Vitamin D deficiency, poor absorption of calcium, phosphorus, and magnesium, delayed pubertal development, and growth failure. A recent systematic review found that longer duration of parenteral nutrition (PN) was associated with a higher risk of metabolic bone disease (MBD) [18]. The role of PN components, including the contribution of aluminum toxicity, on BMD is less clear [18].…”

“…A recent systematic review found that longer duration of parenteral nutrition (PN) was associated with a higher risk of metabolic bone disease (MBD) [18]. The role of PN components, including the contribution of aluminum toxicity, on BMD is less clear [18].…”

The Possible Role of Electrical Stimulation in Osteoporosis: A Narrative Review

“…The diagnosis of osteoporosis mainly relies on dual energy X-ray absorptiometry, and the main measurement sites are the lumbar spine, proximal femur, and distal radius. Generally speaking, the measurement value is less than −2.5 [ 4 , 5 ], and the incidence of osteoporosis is very high. In a community survey of 5585 people with an average age of 77 years old in the UK, it was found that the incidence of osteoporosis was more than 50% [ 6 ].…”