The Prevalence of Vitamin D Insufficiency and Deficiency and Their Relationship with Bone Mineral Density and Fracture Risk in Adults Receiving Long-Term Home Parenteral Nutrition

Abstract

It has been demonstrated that low bone mass and vitamin D deficiency occur in adult patients receiving home parenteral nutrition (HPN). The aim of this study is to determine the prevalence of vitamin D insufficiency and deficiency and its relationship with bone mineral density (BMD) and fracture risk in long-term HPN patients. Methods: A retrospective chart review of all 186 patients in the HPN registry followed by the Northern Alberta Home Parenteral Nutrition Program receiving HPN therapy >6 months with a 25 (OH) D level and BMD reported were studied. Results: The mean age at the initiation of HPN was 53.8 (20–79) years and 23 (37%) were male. The mean HPN duration was 56 (6–323) months and the most common diagnosis was short bowel syndrome. Based on a total of 186 patients, 62 patients were categorized based on serum vitamin D status as follows: 1 (24.2%) sufficient, 31 (50%) insufficient and 16 (25.8%) deficient. Despite an average of 1891 IU/day orally and 181 IU/day intravenously vitamin D, the mean vitamin D level was 25.6 ng/mL (insufficiency) and 26.2 ± 11.9 ng/mL in patients with the highest 10-year fracture risk. Conclusion: Suboptimal vitamin D levels are common among patients on long-term HPN despite nutrient intake that should meet requirements.

Bacteria, Bones, and Stones: Managing Complications of Short Bowel Syndrome

“…These results are consistent with a similar Danish study of 167 patients that found vitamin D deficiency in approximately 50% of the patients and osteoporosis in 56.9% . This relationship of vitamin D deficiency and low BMD also holds in different populations around the world as seen in studies from Canada and China, and often the vitamin D levels remain low despite supplementation …”

“…40 This relationship of vitamin D deficiency and low BMD also holds in different populations around the world as seen in studies from Canada and China, and often the vitamin D levels remain low despite supplementation. 46,47 Deficiencies in other related vitamins and minerals such as vitamin K, vitamin C, copper, and fluoride can play a role in SBS leading to MBD. Vitamin K is typically synthesized by normal gut flora that can be disrupted in SBS.…”

Parenteral Provision of Micronutrients to Adult Patients: An Expert Consensus Paper

“…In HPN patients, vitamin D levels should be monitored every 12 months and corrected accordingly (IM, separate IV infusion or higher PN dose) . Bone mineral density measurements should also be done annually in long‐term HPN patients …”

“…The decision to monitor micronutrient status biochemically may be considered in clinical situations that represent follow up after micronutrient replacement therapies are provided, routine surveillance of patients receiving long‐term HPN patients, in cases of organ failure (liver or kidney), danger of toxicity necessitates monitoring . Renal function should be considered when vitamins and TEs are supplemented, in case of prolonged (>2 weeks) CRRT, a monthly monitoring of hydrosoluble micronutrients may be considered …”

“…20 Bone mineral density measurements should also be done annually in long-term HPN patients. 66 Micronutrient prescription for HPN patients, as all aspects of HPN management, should be overseen by a multidisciplinary nutrition support team (NST) with skills and experience in managing intestinal failure and HPN. 65 Micronutrient prescriptions for HPN patients should be individually tailored in response to monitoring and clinical changes throughout the duration of a patient's HPN journey.…”