Patients requiring home parenteral nutrition (PN) may develop metabolic
bone disease, the etiology of which can be multifactorial. We report a case of
significantly low bone mass in a postmenopausal woman with history of short
bowel syndrome, renal impairment, and previous radiation exposure who
responded to intermittent subcutaneous administration of parathyroid hormone.
Her bone mineral density normalized after she completed a course of 18 months
of treatment, and a bone isotope scan was negative for skeletal
malignancy.
Get full access to this article
View all access options for this article.
References
1.
Haderslev K, Tjellesen L, Haderslev P, Staun M. Assessment of the
longitudinal changes in bone mineral density in patients receiving home
parenteral nutrition. JPEN J Parenter Enteral Nutr.2004
;28:289–
294.
2.
Cohen-Solal M, Baudoin F, Joly K, et al. Osteoporosis in patients
on long-term home parenteral nutrition: a longitudinal study. J
Bone Miner Res.2003;18:1989–
1998.
3.
Pironi L, Labate AM, Pertkiewicz M, et al. Prevalence of bone
disease in patients on home parenteral nutrition. Clin
Nutr.2002;21:289–
296.
4.
Verhage AH, Cheong WK, Allard JP, Jeejeebhoy KN. Increase in lumbar
spine bone mineral content in patients on long-term parenteral nutrition
without vitamin D supplementation. JPEN J Parenter Enteral
Nutr.1995;19:421–
436.
5.
de Vernejoul MC, Messing B, Modrowski D, Bielakoff J, Buisine A,
Miravet L. Multifactorial low remodeling bone disease during cyclic total
parenteral nutrition. J Clin Endocrinol Metab.1985
;60:109–
113.
6.
Pironi L, Tjellesen L, De Francisco A, et al. Bone mineral density
in patients on home parenteral nutrition: a follow-up study. Clin
Nutr.2004;23:1288–
1302.
Iwamoto J, Takeda T, Sato Y. Effects of vitamin K2 on osteoporosis.
Curr Pharm Des.2004
;10:2557–
2576.
9.
Miki T, Nakatsuka K, Naka H, et al. Effect and safety of
intermittent weekly administration of human parathyroid hormone 1–34 in
patients with primary osteoporosis evaluated by histomorphometry and
microstructural analysis of iliac trabecular bone before and after 1 year of
treatment. J Bone Miner Metab.2004
;22:569–
576.
10.
Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of parathyroid
hormone (1–34) on fractures and bone mineral density in post-menopausal
women with osteoporosis. N Engl J Med.2001
;344:1434–
1441.
11.
El-Desouki M, Al-Jurayyan N. Bone mineral density and bone
scintigraphy in children and adolescents with osteomalacia. Eur J
Nucl Med.1997;24:202–
205.
12.
Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R.
Estimates of optimal vitamin D status. Osteoporos Int.2005
;16:713–
716.
13.
Shike M, Shils ME, Heller A, et al. Bone disease in prolonged
parenteral nutrition: osteopenia without mineralization defect. Am
J Clin Nutr.1986;44:89–
98.
14.
Shike M, Sturtridge WD, Tam CS, et al. A possible role of vitamin D
in the genesis of parenteral-nutrition-induced metabolic bone disease.
Ann Intern Med.1981
;95:560–
568.
15.
Harrison JE, Jeejeebhoy KN, Track NS. The effect of total
parenteral nutrition (TPN) on bone mass. In: Coburn JW, Klein GL, eds.
Metabolic Bone Disease in Total Parenteral Nutrition.
Baltimore, MD: Urban and Schwarzenberg; 1985:53
.
16.
Canada T. Aluminum exposure through parenteral nutrition
formulations: mathematical versus clinical relevance. Am J Health
Syst Pharm.2005;62:315–
318.
17.
Black DM, Bilezikian JP, Ensrud KE, et al. One year of alendronate
after one year of parathyroid hormone (1–84) for osteoporosis.
N Engl J Med.2005
;353:555–
565.