Reducing Metabolic Bone Disease Burden in Intestinal Failure Children on Home Parenteral Nutrition

Andreas Tridimas; Raja Padidela; John Bassett; Rachel Wood; Maureen Lawson; Andrew Fagbemi; Timothy J Morris

doi:10.1097/PG9.0000000000000368

Reducing Metabolic Bone Disease Burden in Intestinal Failure Children on Home Parenteral Nutrition

JPGN Rep. 2023 Nov 6;4(4):e368. doi: 10.1097/PG9.0000000000000368. eCollection 2023 Nov.

Authors

Andreas Tridimas^{1

2}, Raja Padidela^{3

4}, John Bassett¹, Rachel Wood⁵, Maureen Lawson⁶, Andrew Fagbemi⁶, Timothy J Morris^{1

7}

Affiliations

¹ From the Directorate of Clinical Biochemistry, Manchester University NHS Foundation Trust, Manchester, UK.
² Clinical Biochemistry Department, Countess of Chester Hospital, Chester, UK.
³ Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK.
⁴ Faculty of Biology Medicine and Health, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK.
⁵ Department of Therapy and Dietetics, Royal Manchester Children's Hospital, Manchester, UK.
⁶ Department of Paediatric Gastroenterology, Royal Manchester Children's Hospital, Manchester, UK.
⁷ Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.

Abstract

Objective: To determine the prevalence of secondary hyperparathyroidism in a cohort of pediatric patients receiving home parenteral nutrition.

Methods: For a service review, a population-based cohort of 37 pediatric intestinal failure patients receiving long-term parenteral nutrition that underwent serial biochemical monitoring during a study period of approximately 4 years were examined. Following the production of an algorithm, a follow-up audit was carried out (n = 33) after approximately 6 months.

Results: Of the 37 patients examined in the initial service review, 22 (59%) were found to have an elevated parathyroid hormone (PTH) during the period of monitoring and 5 (14%) had a persistently elevated PTH. In the follow-up audit following the implementation of an algorithm, the number with elevated PTH reduced to 6 (18%) and no patients had persistently high levels.

Conclusion: Elevated PTH is a common biochemical finding in pediatric intestinal failure patients receiving home parenteral nutrition and its presence should alert clinicians to the need to optimize nutritional parameters such as calcium to phosphate molar ratio and vitamin D status; failure to do so may increase the future burden of metabolic bone disease in such patients. We propose that an algorithm may help in this endeavor.

Keywords: calcium: phosphate molar ratio in parenteral nutrition; children; home parenteral nutrition; intestinal failure; metabolic bone disease; vitamin D.

Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.